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Abstract: FR-PO200

Minimal Change Disease With Immune Checkpoint Inhibitors

Session Information

Category: Onconephrology

  • 1600 Onconephrology

Authors

  • Kethineni, Rama, University of Utah Health, Salt Lake City, Utah, United States
  • Ohri, Ritika, University of Utah Health, Salt Lake City, Utah, United States
  • Barry, Marc, University of Utah Health, Salt Lake City, Utah, United States
  • Gilligan, Sarah, University of Utah Health, Salt Lake City, Utah, United States
  • Abraham, Josephine, University of Utah Health, Salt Lake City, Utah, United States
Introduction

Immune checkpoint inhibitor (ICI)-related acute kidney injury (AKI) occurs in 2-5% of patients treated with these agents. Acute interstitial nephritis is the most common finding on renal biopsy but glomerular disease accounts for approximately 10% of ICI-related AKI. We present a case of minimal change disease secondary to ICI.

Case Description

A 72-year-old male with history of testicular cancer s/p orchiectomy and chemoradiation in 2004, nephrolithiasis, GERD, and newly diagnosed metastatic melanoma presented with poor oral intake, cough, and shortness of breath. The patient had been taking omeprazole and was on the 2nd cycle of ipilimumab and nivolumab.

Labs showed hemoglobin 10.9 mg/dl, Platelets 144, Albumin 1.9 g/dl, BUN 64 mg/dl, and creatinine 2.56 mg/dl from baseline of 1.2 mg/dl. Urinalysis showed protein and 6 RBCs, eumorphic on microscopy. UACR was 7390 mg/g with a UPCR of 9989 mg/g. Serology was negative for ANA, ANCA, HIV, hepatitis with normal C3, C4, and PLA2R 1:10. Renal ultrasound showed no obstruction.

Renal biopsy showed minimal change disease with diffuse foot process effacement along with ATN and less than 10% IFTA. His creatinine worsened despite holding chemotherapy to 6.5 with BUN of 150 mg/dl with uremia requiring RRT. Prednisone was initiated at 1 mg/kg with gradual renal recovery and discontinuation of dialysis after 2 sessions. Prednisone was tapered over 4 months with resolution of albuminuria but with new baseline creatinine of 1.5-1.6 mg/dl. He was rechallenged with a Nivolumab-only regimen and developed hepatitis and worsening renal failure.

Discussion

Minimal change disease is a rare complication of ICI but should be considered in the differential diagnosis of ICI-related AKI. Treatment with steroids often results in at least partial renal recovery but many questions remain regarding prognosis and re-initiation of ICI.