Acute interstitial nephritis related to immune checkpoint inhibitors.
BACKGROUND
Immune checkpoint inhibitors (anti-PD1 or anti-CTLA-4) are increasingly used in various cancers. Immune checkpoint inhibitors (ICI)-related renal disorders are poorly described (9 cases) and were only related to Ipilimumab.


METHODS
Retrospective collection of clinical charts of all the patients admitted for renal disorders following ICI in the University Hospital of Toulouse (France).


RESULTS
We report on adverse renal events that occurred in three patients treated with anti-PD1 (nivolumab or pembrolizumab) or anti-CTLA-4 (ipilimumab). Acute kidney injury occurred at 4-12 weeks after initiation of treatment, and harbored features of tubulo-interstitial nephritis (interstitial polymorphic inflammatory infiltrate with predominant CD3+ CD4+ T cells, associated with granuloma in one). Following withdrawal of ICI and steroid intake, estimated glomerular-filtration rate had improved in all patients.


CONCLUSIONS
These data suggest that all ICI can lead to acute interstitial nephritis, possibly related to the presence of autoreactive clonal T cells. We recommend that patients receiving ICI should undergo renal monitoring every 2 weeks for 3-6 months.
Département de Néphrologie et Transplantation d'organes, Centre de référence des maladies rénales rares, Hôpital Rangueil, Toulouse, France.
Julie
J
Belliere
Service de Dermatologie-Oncologie, Institut Universitaire du Cancer de Toulouse-Oncopôle, Toulouse, France.|INSERM UMR 1037-CRCT, Toulouse, France.|Université Toulouse-III, Toulouse, France.
Nicolas
N
Meyer
Université Toulouse-III, Toulouse, France.|Service de Pneumologie, Hôpital Larrey, Toulouse, France.
Julien
J
Mazieres
Service de Médecine interne et Immunologie clinique, Institut Universitaire du Cancer de Toulouse-Oncopôle, Toulouse, France.
Sylvie
S
Ollier
Service de Dermatologie-Oncologie, Institut Universitaire du Cancer de Toulouse-Oncopôle, Toulouse, France.
Serge
S
Boulinguez
Laboratoire d'Anatomopathologie, Institut Universitaire du Cancer de Toulouse-Oncopôle, Toulouse, France.
Audrey
A
Delas
Département de Néphrologie et Transplantation d'organes, Centre de référence des maladies rénales rares, Hôpital Rangueil, Toulouse, France.
David
D
Ribes
Département de Néphrologie et Transplantation d'organes, Centre de référence des maladies rénales rares, Hôpital Rangueil, Toulouse, France.|Université Toulouse-III, Toulouse, France.|INSERM U1048, Equipe 12 (Fibrose rénale), Institut des Maladies métaboliques et cardiovasculaires, Toulouse, France.
Stanislas
S
Faguer
D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D059447:Cell Cycle Checkpoints; D005260:Female; D006801:Humans; D000074324:Ipilimumab; D008875:Middle Aged; D009395:Nephritis, Interstitial / Q000276:immunology*; D012189:Retrospective Studies
D000911:Antibodies, Monoclonal; D000074324:Ipilimumab