Abstract: FR-PO0453
A Case of Pembrolizumab-Induced Minimal Change Disease
Session Information
- AKI: Case Reports - TMA, Vasculitis, Immune-Mediated Injury, and Systemic Disease
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Poblete, Alexander, Inova Fairfax Hospital, Falls Church, Virginia, United States
- Siva, Reva, Creighton University School of Medicine, Omaha, Nebraska, United States
- Regunathan-Shenk, Renu, Inova Fairfax Hospital, Falls Church, Virginia, United States
Introduction
Pembrolizumab, an immune checkpoint inhibitor (ICI), is first-line therapy for many malignancies, including renal cell carcinoma (RCC). We report a case of pembrolizumab-induced minimal change disease (MCD) causing hemodialysis (HD)-dependent acute kidney injury (AKI) in a patient (Pt) with metastatic RCC.
Case Description
A 54-year-old man with metastatic RCC and hypertension presented with AKI on routine labs. Eight weeks prior he had started pembrolizumab every 6 weeks for RCC.
Following his second dose, he developed AKI progressive over 2 weeks and was referred to the hospital, where admission labs showed SCr 6.0 mg/dL (baseline 0.8 mg/dL) as well as phosphorus 8.1 g/dL and UPCr 17.5. 24-hour urine protein confirmed 17.4 g proteinuria. He reported diarrhea but no urinary symptoms. There was new bilateral lower extremity edema on exam.
He received 3 days IV methylprednisolone without improvement and immunotherapy was held. HD was initiated on hospital day 5.
Renal biopsy showed acute tubular necrosis on light microscopy and electron microscopy showed diffuse podocyte effacement consistent with MCD, likely pembrolizumab-induced.
He was discharged on intermittent HD and prednisone taper. Cancer regimen was changed to cabozantinib. At 2 month follow up, SCr improved to 0.65 mg/dL and proteinuria to 165 mg/dL. HD was discontinued.
Pembrolizumab was restarted 1 month later due to RCC progression. Ten days later he was readmitted with bilateral pleural effusion and SCr 1.1 mg/dL and UPCr 6.7 consistent with recurrent MCD. His symptoms improved with IV diuresis and he was discharged with a second prednisone taper. Pembrolizumab was discontinued and changed to lenvatinib. His subsequent clinical course was complicated by mucositis, esophageal candidiasis, and failure to thrive and he passed away at home.
Discussion
This case highlights ICI-induced MCD causing HD-dependent AKI with a clear temporal association between AKI and repeated pembrolizumab exposures. While ATIN is most commonly reported in ICI-related AKI, glomerular pathology should also be considered.