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Abstract: FR-PO203

ANTI-PLA2R Positive Membranous Nephropathy Associated With Atezolizumab: A Case Report

Session Information

Category: Onconephrology

  • 1600 Onconephrology


  • Oleas, Diana, Consorci Sanitari De Terrassa, Terrassa, Barcelona, Spain
  • Tapia, Irati, Consorci Sanitari De Terrassa, Terrassa, Barcelona, Spain

Immunotherapy has transformed cancer treatment in advanced malignancies. Increased survival compared with the standard of care has made immunotherapy a fundamental component of oncotherapeutics. Immune checkpoint inhibitors (ICI) trigger a potent stimulus to kill cancer cells. Immune-related adverse events (irAEs) secondary to ICI affect diverse organs. Acute interstitial nephritis is the most frequent kidney irAE. Glomerulopathies, although rare, constitute a more challenging diagnosis and treatment.

Case Description

A 72-year-old man with lung adenocarcinoma treated with Bevacizumab and Atezolizumab. During treatment, he developed nephrotic syndrome. A diagnosis of a phospholipase A2 receptor-positive primary membranous nephropathy associated with atezolizumab was made. After failing to respond to steroid therapy, treatment with rituximab was the preferred option. Eight months after being treated with rituximab and ten months after atezolizumab was stopped, the patient maintained preserved renal function and negativization of anti-PLA2R was achieved. Proteinuria declined to half of its initial value five months following anti-PLA2R negativization.


As we have described, glomerular involvement, like membranous nephropathy, yet not frequent, could cause a high disease burden and affect the oncological and renal outcomes. We believe monitoring for proteinuria during treatment with ICI is crucial to determine an indication for a timely kidney biopsy and treatment.