Abstract: SA-PO178
Incidence of Nephrotoxicity Secondary to PD-1/PD-L1 Inhibition: A Single Health Center Experience
Session Information
- Onco-Nephrology: Clinical
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onco-Nephrology
- 1500 Onco-Nephrology
Authors
- Zhang, Ping L., Beaumont Health System, Royal Oak Campus, Royal Oak, Michigan, United States
- Kanaan, Hassan D., Beaumont Health System, Royal Oak Campus, Royal Oak, Michigan, United States
- Li, Wei, Beaumont Health System, Royal Oak Campus, Royal Oak, Michigan, United States
Background
Immuno-check point inhibitors (CPI) such as PD-1/PD-L1 inhibitors alone or in combination with other chemotherapeutic medications have been used to treat variety of metastatic neoplasms with amazing effects in recent years. However, cases of their associated nephrotoxicity become more often seen. Here we present a single health center experience of identifying CPI associated nephrotoxicities in renal biopsies and their follow-up data.
Methods
Over past 17 months (till April 2019), we have had approximately 620 cases of renal biopsies from our eight-hospital system (4000 beds in total) in Southeast Michigan. Seven indicated native renal biopsies were performed to evaluate renal pathology in patietns who were treated with CPI for various metastatic neoplasms, but developed acute kidney injury. Conventional light microscopy, immunofluorescent stains and electromicroscopy wrere used to assess renal pathology and clinical correlations were conducted.
Results
The cases are summarized in Table below. The identified cases represent 1.1 % of our renal biopsies. Typical acute interstitial nephritis (AIN) (composed of dominant CD3 positive T lymphocytes) was seen in five of seven patients (Table below) but remaining two patients’ biopsies without AIN had either chromic thrombotic microangiopathy (TMA) or acute tubular injury (ATI). Three out the five patients with CPI induced AIN had significant recovery of renal function after steroid treatment, while other two AIN cases had limited renal functional recovery.
Conclusion
Since our first cases seen at the end of 2017, there have been increased incidence of nephrotoxcitiy cases due to CPI treatment, most characterized by T lymphocytes mediated AIN. Some patients had a good renal function recovery in response to steroid treatment.
Clinical and Pathologic Indices, and Follow-up Renal Function
| Age/Gender/Tumors | CPI | Pre-sCr (mg/dl) | Biopsy diagnosis | Follow-up sCr (mg/dl) |
| 68M, renal cell carcinoma | Opdivo | 8.3 | AIN, moderate | 2.47 |
| 62M, lung cancer | Keytruda | 2.0 | AIN, moderate | 1.93 |
| 66M, lung cancer | Keytruda | 4.0 | AIN, moderate | 1.01 |
| 84F, lung adenocarcinoma | Opdivo | 2.7 | AIN, mild | 0.95 |
| 82M, melanoma | Opdivo | 2.9 | TMA | 1.77 |
| 38M, bladder cancer | Keytruda | 2.0 | AIN, mild | 1.89 |
| 77M, lung cancer | Keytruda | 1.9 | ATI, mild | 1.15 |
M - male; F - female