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Abstract: FR-PO278

Immunotherapy-Related Renal Sarcoidosis in a Patient with Metastatic Melanoma

Session Information

Category: Onconephrology

  • 1700 Onconephrology


  • Rao Ullur, Avinash, University of Toronto, Toronto, Ontario, Canada
  • John, Rohan, University of Toronto, Toronto, Ontario, Canada
  • Kitchlu, Abhijat, University of Toronto, Toronto, Ontario, Canada

Immune checkpoint inhibitors (ICIs) are widely used as standard of care therapy in management of metastatic melanoma. There have been various reported kidney complications associated with these treatments, though immunotherapy-related sarcoid-like reactions (SLRs) with kidney involvement are rare.

Case Description

A 57-year-old lady was diagnosed with metastatic melanoma stage IV and received first line Ipilimumab/Nivolumab followed by Nivolumab monotherapy q3 weekly. Her therapy was interrupted by an asymptomatic rise in serum creatinine (sCr) from a baseline of 0.9 mg/dL to 2.14 mg/dL with an incidentally detected serum calcium (sCa) of 13.23 mg/dL. She was managed with hydration & bisphosphonates. As sCr and sCa remained elevated with further ICI challenges, her treatment was changed to targeted therapy with oral Dabrafenib/Trametinib. Her melanoma remained in remission, but she persisted to have high sCr and sCa. Metabolic work-up revealed presence of hypercalciuria and elevated serum 1,25-(OH)2 vitamin D. A CT chest was suspicious for granulomatous disease, but bronchoalveolar lavage result was equivocal. The patient underwent a kidney biopsy which revealed findings consistent with sarcoidosis. She initially responded to oral steroids. As her disease remained steroid dependent, therapy was switched to oral mycophenolate mofetil. Patients' sCr has remained stable at 1.5 mg/dL after 4 months of follow up.


In the presented case, it appears that renal SLR was related to immunotherapy as kidney dysfunction and hypercalcemia occurred after the patient was initiated on treatment. Renal SLR may also have been perpetuated with continuation of the treatment with targeted therapy, as Dabrafenib/Trametinib treatment has also been associated with SLR. In such situations, treating SLRs with steroids or immunosuppressive agents may be a reasonable option to allow continuation of therapy.

Interstitial nephritis with non-necrotizing granulomas.