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Abstract: FR-PO207

AKI and "Pseudo-Pyelonephritis" Caused by Immune Checkpoint Inhibitors

Session Information

Category: Onconephrology

  • 1600 Onconephrology

Authors

  • Stalbow, Daniel, Weill Cornell Medicine, New York, New York, United States
  • Glezerman, Ilya, Memorial Sloan Kettering Cancer Center, New York, New York, United States
  • Seshan, Surya V., Weill Cornell Medicine, New York, New York, United States
  • Salvatore, Steven, Weill Cornell Medicine, New York, New York, United States
  • Gutgarts, Victoria, Memorial Sloan Kettering Cancer Center, New York, New York, United States
Introduction

Immune checkpoint inhibitors (ICPis) have an incidence of renal toxicity that ranges from 1 to 5%. ICPi-associated AKI (ICPi-AKI) presents as asymptomatic rise in serum creatinine. Associated symptoms of dysuria, flank pain, fever and radiologic evidence of renal inflammation are rare.

Case Description

Herein we describe three cases (Table below) of biopsy proven ICPi-AKI presenting with dysuria, flank pain and imaging consistent with genitourinary inflammation (Figure below). All patients were empirically treated with antibiotics for suspected infections though urine cultures were negative. Persistent symptoms and rising creatinine led to kidney biopsy which showed acute interstitial inflammation without significant neutrophil infiltration in all three cases. A course of steroids led to the resolution of symptoms and improvement in serum creatinine.

Discussion

These cases highlight the complexity of ICPi-AKI that is not limited to laboratory and histology abnormalities but includes symptoms and imaging consistent with inflammation of the genitourinary tract. If overlooked, patients will be mistreated for an infection causing symptoms to persist and a delay in initiation of immunosuppression.

Three cases of ICPi-AKI presenting with dysuria and imaging consistent with genitourinary inflammation
PatientCancerICPi TypeBaseline Creatinine (mg/dL)Peak Creatinine at Time of AKI (mg/dL)Symptoms After Start of ICPiCT ImagingUrine CultureRenal Biopsy FindingsNadir Creatinine (mg/dL)
57FBreast CancerPD-10.71.8Dysuria, flank pain, fevers x 1 monthBilateral perinephric stranding, urothelial thickening, and cystitisNegativeActive tubulointerstitial nephritis, moderately severe.0.9
62MMelanomaPD-1 and CTLA-414Abdominal pain x 11 daysBilateral perinephric fat stranding and urothelial thickeningNegativeAcute tubulointerstitial nephritis1
46MGastric CancerPD-10.83.7Bilateral flank pain x 7 daysBilateral perinephric fat stranding and urothelial thickeningNegativeSevere active tubulointerstitial nephritis with granulomatous changes.1.1