Abstract: TH-PO0208
A Rare Case of Kidney Injury from Radioligand Therapy
Session Information
- Onconephrology: Anticancer Therapies, PTLD, Paraneoplastic Diseases, and More
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1700 Onconephrology
Authors
- Radhakrishna, Roshni, The Nephrology Clinic, Fort Collins, Colorado, United States
- Sethi, Sanjeev, Mayo Clinic Minnesota, Rochester, Minnesota, United States
Introduction
Lutetium Lu-177 vipivotide tetraxetan is a Prostate Specific Membrane Antigen (PSMA)-targeted radioligand therapy approved for treatment of metastatic castration-resistant prostate cancer (mCRPC). Data on long term renal adverse effects of this therapy is limited. Here we describe a case of kidney injury following 177Lu-PSMA radioligand therapy.
Case Description
76 yo male with history of metastatic prostate cancer treated with ADT followed by radical prostatectomy and adjuvant radiation therapy was referred to Nephrology for acute kidney injury following 177Lu-PSMA therapy. He had been on ADT previously with progression on multiple agents including enzalutamide, abiraterone/prednisone and darolutamide. Testosterone was suppressed but PET scan showed widespread metastatic disease involving multiple lymph nodes, peritoneum and axial skeleton. He was subsequently started on 177Lu-PSMA therapy and completed 6 treatments over 7 months. Kidney function remained stable at his baseline with Cr 1-1.1 but was noted to be elevated to 1.34 two months after completion of radioligand therapy and by month 7, further elevated to 2.8. UA showed proteinuria and microscopic hematuria with UPCR 2g. Renal US showed no hydronephrosis. Serologic work up was unrevealing including complements, anti dsDNA, ANCA, antiGBM and AntiPLA2R antibody, HIV, Hepatitis B and C. SPEP and UPEP showed no monoclonal protein with unremarkable FLC ratio. ANA was positive with a positive RNP antibody, of unclear significance. Repeat PET scan showed no PSMA avid disease. PSA remained <1. Renal biopsy with ultrastructural studies showed moderate arteriosclerosis, subendothelial and mesangial expansion with fluffy granular material, double contour of basement membrane consistent with Thrombotic Microangiopathy attributed to radioligand therapy. Renal function continued to deteriorate with Cr 4 range at 15 months since therapy cessation.
Discussion
177Lu-PSMA ligand therapy in mCRPC targets PSMA expressing cells and improves overall survival. Renal tubular PSMA expression raises concern for potential nephrotoxicity from retention of the radioligand but data on renal adverse effects is limited. Three other cases of progressive renal injury from Thrombotic Microangiopathy following this treatment have been reported. More studies are needed on long term renal adverse effects of these agents as they are increasingly being utilized for treatment of mCRPC.