PDF(Pubmed)
Abstract：
BACKGROUND: Recent studies have focused on immune checkpoint inhibitors. Renal complications associated with the use of immune checkpoint inhibitors are uncommon compared with other immune-related adverse events. Acute interstitial nephritis accounts for most of these renal complications, with nephrotic syndrome quite rare. We herein report a case of nephrotic syndrome associated with immune checkpoint inhibitors that was more severe than that in previous cases. By comparing this case with previous reports, the possible reasons for the particular severity of this case are discussed.
METHODS: A 75-year-old man developed nephrotic syndrome with acute kidney injury after the first combination therapy of nivolumab and ipilimumab for malignant pleural mesothelioma. The results of a kidney biopsy indicated minimal change disease with mild atherosclerosis, acute interstitial nephritis, and fusion of nearly all podocyte foot processes. Nivolumab and ipilimumab therapy were stopped, and treatment with corticosteroids was initiated. We investigated previously reported cases of nephrotic syndrome using immune checkpoint inhibitors. Seventeen cases of immune checkpoint inhibitor-related nephrotic syndrome, including ours, have been reported. Two of the 17 patients with immune checkpoint inhibitor-related nephrotic syndrome required hemodialysis treatment for acute kidney injury. Unlike many previously reported cases, the present patient was administered two different immune checkpoint inhibitors, which may be one of the reasons for the development of severe nephrotic syndrome.
CONCLUSIONS: In addition to previously reported risk factors, immune checkpoint inhibitor combination therapy can exacerbate nephrotic syndrome compared to immune checkpoint inhibitor monotherapy.
METHODS: A 75-year-old man developed nephrotic syndrome with acute kidney injury after the first combination therapy of nivolumab and ipilimumab for malignant pleural mesothelioma. The results of a kidney biopsy indicated minimal change disease with mild atherosclerosis, acute interstitial nephritis, and fusion of nearly all podocyte foot processes. Nivolumab and ipilimumab therapy were stopped, and treatment with corticosteroids was initiated. We investigated previously reported cases of nephrotic syndrome using immune checkpoint inhibitors. Seventeen cases of immune checkpoint inhibitor-related nephrotic syndrome, including ours, have been reported. Two of the 17 patients with immune checkpoint inhibitor-related nephrotic syndrome required hemodialysis treatment for acute kidney injury. Unlike many previously reported cases, the present patient was administered two different immune checkpoint inhibitors, which may be one of the reasons for the development of severe nephrotic syndrome.
CONCLUSIONS: In addition to previously reported risk factors, immune checkpoint inhibitor combination therapy can exacerbate nephrotic syndrome compared to immune checkpoint inhibitor monotherapy.
摘要：
背景：最近的研究集中在免疫检查点抑制剂上。与其他免疫相关的不良事件相比，与使用免疫检查点抑制剂相关的肾脏并发症并不常见。急性间质性肾炎占这些肾脏并发症的大部分，肾病综合征相当罕见。我们在此报告一例与免疫检查点抑制剂相关的肾病综合征，比以前的病例更严重。通过将此案例与以前的报告进行比较，讨论了这种情况特别严重的可能原因。
方法：一名75岁男子在首次使用纳武单抗和伊匹单抗联合治疗恶性胸膜间皮瘤后出现肾病综合征伴急性肾损伤。肾活检的结果显示微小病变伴轻度动脉粥样硬化，急性间质性肾炎,和几乎所有足细胞足突的融合。Nivolumab和ipilimumab治疗停止，开始使用皮质类固醇治疗。我们调查了以前报道的使用免疫检查点抑制剂的肾病综合征病例。免疫检查点抑制剂相关性肾病综合征17例,包括我们的,已被报道。17例免疫检查点抑制剂相关性肾病综合征患者中有2例需要血液透析治疗急性肾损伤。与以前报道的许多病例不同，本患者服用了两种不同的免疫检查点抑制剂，这可能是严重肾病综合征发展的原因之一。
结论：除了先前报告的风险因素，与免疫检查点抑制剂单药治疗相比,免疫检查点抑制剂联合治疗可加重肾病综合征.
方法：一名75岁男子在首次使用纳武单抗和伊匹单抗联合治疗恶性胸膜间皮瘤后出现肾病综合征伴急性肾损伤。肾活检的结果显示微小病变伴轻度动脉粥样硬化，急性间质性肾炎,和几乎所有足细胞足突的融合。Nivolumab和ipilimumab治疗停止，开始使用皮质类固醇治疗。我们调查了以前报道的使用免疫检查点抑制剂的肾病综合征病例。免疫检查点抑制剂相关性肾病综合征17例,包括我们的,已被报道。17例免疫检查点抑制剂相关性肾病综合征患者中有2例需要血液透析治疗急性肾损伤。与以前报道的许多病例不同，本患者服用了两种不同的免疫检查点抑制剂，这可能是严重肾病综合征发展的原因之一。
结论：除了先前报告的风险因素，与免疫检查点抑制剂单药治疗相比,免疫检查点抑制剂联合治疗可加重肾病综合征.
