Interstitial nephritis with pembrolizumab: A case report and review

Abstract

Introduction Pembrolizumab is a monoclonal antibody approved for adult patients with advanced non–small-cell lung cancer (NSCLC). Although immune related adverse events are considered to be well tolerated, complications may occur and discontinuation of the treatment could be required. Case report A 62-year old patient diagnosed with advanced non-small cell lung cancer experienced a decline in the renal function after seven cycles with pembrolizumab. Management & outcome: After ruling out other common causes of interstitial nephritis, pembrolizumab was attributed as a cause of interstitial nephritis. At first, toxicity was managed with corticosteroids and closely monitoring the patient, but finally pembrolizumab had to be discontinued due to the kidney function did not recover. Discussion Renal and urinary disorders were reported in <3% of patients treated with pembrolizumab, being interstitial nephritis the most reported toxicity. The kidney damage can be a complication to consider in patients receiving pembrolizumab. Early identification of an increase in serum creatinine levels may help with prevention by establishing an effective treatment, although it may not mean a total recovery of kidney function.

Chronic Kidney Disease and Cancer: Inter-Relationships and Mechanisms

“…Pembrolizumab was a humanized monoclonal anti-programmed death 1 (PD1) pathway antibody that has been extensively investigated in numerous malignancies ( Kwok et al, 2016 ). Pelaez Bejarano et al showed a case of non-small cell lung cancer treated with Pembrolizumab who developed concurrent AKI, which was diagnosed with interstitial nephritis and finally progressed to CKD stage G2-G3, although Pembrolizumab was stopped immediately and hormone treatment was added ( Pelaez Bejarano et al, 2021 ). In situ hybridization and immunohistochemical staining showed that mRNA and protein levels of programmed death ligand-1 (PD-L1) were expressed, though relatively low, in proximal tubules of normal kidney ( Ding et al, 2005 ).…”

Renal function outcomes in patients with muscle‐invasive bladder cancer treated with neoadjuvant pembrolizumab and radical cystectomy in the PURE‐01 study

“…The use of pembrolizumab, a selective humanized IgG4 kappa monoclonal antibody that inhibits the programmed death‐1 receptor, is currently approved by the United States Food and Drug Administration (US‐FDA) and the European Medicines Agency (EMA) as the standard of care across several types of malignancies and different clinical stages. However, different studies demonstrated that in a small percentage of cases (less than 2%), 1 pembrolizumab may cause acute kidney injury (AKI) associated with the development of acute tubular injury, acute interstitial nephritis and minimal change disease. These histopathological conditions leading to AKI development are in line with the kidney toxicity observed in other immune checkpoint inhibitors even though only a few multicentric studies have deep investigated the relationship between immune checkpoint inhibitors dosage and the acute renal grade of dysfunction 2 …”