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Kidney Week

Abstract: FR-OR019

Renal Immune Related Adverse Events in Patients Treated with PD-1 Inhibitors: An Emerging Complication of Immunotherapy

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Glezerman, Ilya, Memorial Sloan Kettering Cancer Center, New York, New York, United States
  • Latcha, Sheron, Memorial Sloan Kettering Cancer Center, New York, New York, United States
  • Jaimes, Edgar A., Memorial Sloan Kettering Cancer Center, New York, New York, United States
Background

Inhibition of programmed cell death protein 1 (PD-1) immune checkpoint pathway activates patient’s immune system, which is responsible for anti-tumor effect but may cause unwanted immune-related adverse events (IrAE) including renal effects.

Methods

Retrospective review of cases of acute kidney injury (AKI) or nephrotic syndrome while on treatment with PD-1 inhibitors seen at MSKCC between 2012 and 2018. Patients concurrently treated with another checkpoint therapy were excluded.

Results

Thirty-one patients were identified and twenty-three met inclusion criteria. Eight were male and the average age was 61.7 years. Fourteen patients had a biopsy while nine were treated empirically. The mean number of immunotherapy cycles prior to onset of AKI was 5.08 (1-14). In the biopsy group (Table 1), thirteen patients had AIN and one had membranous glomerulonephropathy (MGN). All had either full or partial recovery of renal function. Two patients were re-challenged with PD-1 inhibitors and tolerated 2 and 5 cycles respectively accompanied by low dose steroid therapy. One patient was re-challenged without corticosteroids and AKI recurred after 10 cycles. One patient with biopsy proven AIN received 5 additional cycles without further worsening of renal function. The patient with MGN developed a relapse after re-challenge with checkpoint inhibitor but tolerated additional 5 cycles with supportive care.

Conclusion

Most patients with renal IrAE developed AIN and all recovered kidney function. These patients can be re-challenged with PD-1 inhibitors if clinically indicated with concomitant steroid therapy support.

PatientAge
(years)
Gender
(M/F)
Baseline SCr*
(mg/dL)
Peak SCr
(mg/dL)
Urinalysis
findings
Check-point
number of cycles
Nephritis
treatment
Re-challenge
with
check point
Last
SCr
(mg/dl)
Biopsy
Findings
171F0.86.5Pyuria
Eosinophil 2%
3Steroid taperNo1.3AIN**
271F1.32.1Albumin 100
Pyuria
5-10 RBC/HPF
5NoneNo1.4AIN
383F0.91.9Pyuria
9 RBC/HPF
8NoneNo1.0AIN
462F0.61.3Pyuria
5 RBC/HPF
3Steroid taper and maintenanceYes
(2 doses)
1.0AIN
569M1.11.76-10 WBC/HPF5Steroid taperx2Yes
(5 doses)
1.5AIN
673F0.85.1Albumin 1001Steroid taperNo1.1AIN
758F1.21.6Bland8Steroid taperNo1.0AIN
875M1.11.0Albumin >10006Steroid taperYes-partial remission and recurrence0.6MGN†
PLA2R Neg
973M1.03.3Bland10Steroid taperNo1.5AIN
1069M1.33.9Albumin trace2Steroid taperNo1.4AIN
1174F0.74.5Albumin trace7Steroid taperNo1.2AIN
1250F0.61.5Bland5Steroid taperNo1.0AIN
1367F0.71.9trace hematuria
9RBC/HPF
4Steroid taperNo1.2AIN
1445M0.81.5Bland3NoneYes
(5 doses)
1.0AIN

Funding

  • Other NIH Support