Kidney Week

Abstract: FR-PO0751

PD-1 Pathway Inhibition: Potential Trigger of Anti-GBM Glomerulonephritis

Session Information

• Glomerular Diseases: ANCA Vasculitis, Anti-GBM Disease, and Crescentic GN
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Fine, Rachel L., University of Kentucky, Lexington, Kentucky, United States

Rachel L. Fine, MD

• Younis, Mohamed Ahmed, University of Kentucky, Lexington, Kentucky, United States

Mohamed Ahmed Younis, MD

• Sims, Tyler, University of Kentucky, Lexington, Kentucky, United States

Tyler Sims, MD, CDE

• Ahmed, Sadiq, University of Kentucky, Lexington, Kentucky, United States

Sadiq Ahmed, MD

Introduction

Anti-GBM disease results from antibody interaction with type IV collagen in the renal and pulmonary capillaries and has been linked to environmental triggers in susceptible individuals. Although rare, immunotherapy may also contribute to Anti-GBM disease. We present a rare case of Anti-GBM disease occurring after treatment with PD-1 pathway inhibitor therapy.

Case Description

A 52-year-old female with metastatic melanoma was initially treated with Pembrolizumab before transitioning to Nivolumab due to recurrence. Nivolumab was stopped after she developed immune checkpoint inhibitor–related pneumonitis followed by severe AKI (sCr 9.27) with active urinary sediment. Serology was negative except for markedly elevated anti-GBM IgG antibody levels at 184 AU/mL (0–19). Renal biopsy showed acute crescentic GN with linear IgG (3+) deposition along the GBM. The patient was started on dialysis, daily plasma exchange, IV pulse steroids, and cyclophosphamide. After 14 plasma exchange sessions, the anti-GBM antibody level decreased to 7 AU/mL, but kidney function did not recover, and she remained dialysis-dependent.

Discussion

Our case highlights the importance of considering immune checkpoint inhibitors as a potential rare contributor to Anti-GBM disease. Although anti-GBM glomerulonephritis is considered a type II hypersensitivity reaction, T-cell activity may also play a contributory role. Interstitial nephritis is a known adverse effect of immune checkpoint inhibitors, but reports of glomerulonephritis, especially anti-GBM disease, remain extremely rare, with only a few cases reported ¹. Current National Comprehensive Cancer Network guidelines for immune checkpoint inhibitor–related renal toxicity recommend anti-GBM antibody testing when there is concern for ICI-induced vasculitis or glomerulonephritis ².

Reference:
1. Takahashi N, Tsuji K, Tamiya H, et al. Goodpasture's Disease in a Patient With Advanced Lung Cancer Treated With Nivolumab: An Autopsy Case Report. Lung Cancer. 2018;122:22-24. doi:10.1016/j.lungcan.2018.05.015
2. National Comprehensive Cancer Network. Updated 2025-10-2