Interstitial nephritis in a patient receiving adoptive immunotherapy with recombinant interleukin-2 and lymphokine-activated killer cells.
A patient receiving adoptive immunotherapy with recombinant interleukin-2 (IL-2) and lymphokine-activated killer (LAK) cells for metastatic melanoma developed acute renal insufficiency out of proportion to the decrease in her renal perfusion after 4 days of receiving IL-2. On the 8th day of IL-2 and the 3rd day of LAK cell infusion she expired suddenly from an acute intra-abdominal hemorrhage due to rupture of a metastasis. Postmortem examination of the kidneys showed an interstitial infiltrate consisting largely of lymphocytes and concomitant tubulitis. Immunoperoxidase staining of the infiltrating cells with a panel of lymphocyte-specific monoclonal antibodies showed the majority of cells to be T lymphocytes (70-75%), with a more focal infiltrate of B lymphocytes (25-30%) and rare monocytes, granulocytes and natural killer cells. This patient represents the first reported case of acute interstitial nephritis associated with IL-2 immunotherapy. Our finding is consistent with the hypothesis that the acute renal failure that accompanies this therapy may sometimes be due to intrinsic renal disease as well as the usual pre-renal failure. Nephritis may be caused by IL-2-mediated effects on lymphocytes, resulting in renal parenchymal infiltration.
Feinfeld
D A
DA
Department of Medicine, Nassau County Medical Center, East Meadow, N.Y.
D'Agati
V
V
Dutcher
J P
JP
Werfel
S B
SB
Lynn
R I
RI
Wiernik
P H
PH
D058186:Acute Kidney Injury / Q000209:etiology*; D000328:Adult; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D016219:Immunotherapy, Adoptive / Q000009:adverse effects*; D007376:Interleukin-2 / Q000009:adverse effects*; D007668:Kidney / Q000473:pathology*; D015979:Killer Cells, Lymphokine-Activated / Q000637:transplantation*; D008545:Melanoma / Q000628:therapy; D009395:Nephritis, Interstitial / Q000209:etiology* / Q000473:pathology; D010157:Palatal Neoplasms / Q000628:therapy; D011994:Recombinant Proteins / Q000009:adverse effects; D013601:T-Lymphocytes / Q000473:pathology
D007376:Interleukin-2; D011994:Recombinant Proteins