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Kidney Week

Abstract: PO0042

Pembrolizumab and Proton Pump Inhibitor-Induced Nephrotoxicity: A Case Report

Session Information

Category: Trainee Case Report

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Author

  • Karo, Nicholas L., LewisGale Medical Center, Salem, Virginia, United States

Group or Team Name

  • LewisGale Medical Center
Introduction

Immune checkpoint-blocking antibodies have shown promise in the treatment of a wide-range of malignancies. These medication function by blocking down-regulators of innate immunity, thus augmenting anti-tumor immunity. This upregulation of the immune system can result in immune related adverse events and can affect any organ system. One immune-related adverse event is acute interstitial nephritis. Proton pump inhibitors, themselves, have been implicated in causing acute interstitial nephritis. There is little research regarding synergism of checkpoint inhibitors and proton pump inhibitors and resultant kidney injury. This case report reviews one patient’s clinical course in which they experienced acute interstitial nephritis while receiving both pembrolizumab and omeprazole.

Case Description

A 64 year old female with non-small cell lung cancer stage IV with brain metastasis was initiated on pembrolizumab therapy seven months prior to presentation. Three weeks prior to presentation she started omeprazole 20mg daily. At time of presentation the creatinine was found to be 3.07 mg/dL, up from 0.8 mg/dL eleven days prior, improved with cessation of the PPI, however shortly there after the PPI was restarted and creatinine again rose and peaked at 7.6 mg/dL. Renal biopsy was performed and confirmed interstitial nephritis. The patient was started on prednisone 1mg/kg/day with rapid improvement in renal function back to baseline.

Discussion

There has been some research linking both pembrolizumab and pembrolizumab in combination with other chemotherapeutic agents to kidney injury. However, in these trials many patients who suffered kidney injury were also receiving proton pump inhibitors, a class of medications known to provoke acute interstitial nephritis. If synergism can be proven, this combination would be avoided, thus preventing this immune related adverse event. Furthermore, reinitiation of check point inhibitors alone after cessation of the PPI and normalization of kidney function in cases such as these, could be trialed.