Abstract: FR-PO0471
Severe Pembrolizumab-Induced Acute Tubulointerstitial Nephritis (ATIN) Requiring Temporary Dialysis
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
- Pamulapati, Kusuma Chowdary, Vassar Brothers Medical Center, Poughkeepsie, New York, United States
- Mopuru, Nikhilendhar Nag, Vassar Brothers Medical Center, Poughkeepsie, New York, United States
- Hayat, Amir, Vassar Brothers Medical Center, Poughkeepsie, New York, United States
Introduction
Immune checkpoint inhibitors (ICIs) have transformed cancer therapy, improving survival across a variety of malignancies. Immune activation can disrupt self-tolerance, leading to immune-related adverse events (irAEs) that can affect nearly any organ system (1). Common irAEs include rash, colitis, hepatitis, pneumonitis, endocrinopathies, while renal toxicities are relatively uncommon(1,3).
Case Description
78-year-old male patient with history of diabetes, metastatic renal cell carcinoma admitted for acute renal failure after second dose of Pembrolizumab. His creatinine was 5.8 on presentation with normal baseline. US Renal showed no hydronephrosis. UA showed sterile pyuria. FENA was 3.2% consistent with intrinsic disease. IV fluids and high dose prednisone started with no significant improvement of renal function. He remained oliguric, developed acidosis and edema. Kidney biopsy showed diffuse interstitial inflammation and lymphocytic tubulitis. He needed 3 sessions of dialysis which improved the kidney function. Patient was discharged with a long steroid taper and achieved full renal recovery.
Discussion
ATIN is the commonly reported renal irAE associated with ICIs(2,4). ATIN typically presents with AKI characterized by a rise in creatinine, with nonspecific manifestations like fatigue, nausea, pyuria, hematuria, or mild proteinuria(3,5). Classic triad of fever, rash, and eosinophilia is infrequently observed. Diagnosis is based on clinical suspicion in patients receiving ICIs after excluding other causes, although kidney biopsy remains gold standard for confirmation and demonstrates interstitial inflammation with tubulitis(6). Management includes discontinuation of the offending immunotherapy and initiation of corticosteroid therapy, which often leads to partial or complete renal recovery when recognized early(1,4). This case highlights the importance of prompt recognition of ICI induced ATIN to prevent irreversible renal dysfunction.
Acknowledgment
1. N Engl J Med. 2018 Jan 11;378(2):158-168. 2. Association of Acute Interstitial Nephritis with Programmed Cell Death 1 Inhibitor Therapy in Lung Cancer Patients. 3. Cardiorenal complications of immune checkpoint inhibitors. Nat Rev Nephrol. 2018 Sep;. 4. Renal toxicities associated with pembrolizumab. Clin Kidney J. 2019 Feb;12 5. Adverse Renal Effects of Anticancer Immunotherapy: A Review. Cancers (Basel). 2022 Aug. 6. Renal effects of immune checkpoint inhibitors. Nephrol Dial Transplant.