Belliere Julie, Meyer Nicolas, Mazieres Julien, Ollier Sylvie, Boulinguez Serge, Delas Audrey, Ribes David, Faguer Stanislas
Département de Néphrologie et Transplantation d'organes, Centre de référence des maladies rénales rares, Hôpital Rangueil, Toulouse, France.
Service de Dermatologie-Oncologie, Institut Universitaire du Cancer de Toulouse-Oncopôle, Toulouse, France.
Br J Cancer. 2016 Dec 6;115(12):1457-1461. doi: 10.1038/bjc.2016.358. Epub 2016 Nov 10.
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.
Retrospective collection of clinical charts of all the patients admitted for renal disorders following ICI in the University Hospital of Toulouse (France).
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.
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.
免疫检查点抑制剂（抗程序性死亡蛋白1或抗细胞毒性T淋巴细胞相关抗原4）在各种癌症中的应用越来越广泛。免疫检查点抑制剂（ICI）相关的肾脏疾病描述较少（9例），且仅与伊匹单抗有关。
回顾性收集法国图卢兹大学医院所有因ICI治疗后出现肾脏疾病而入院患者的临床病历。
我们报告了3例接受抗程序性死亡蛋白1（纳武单抗或派姆单抗）或抗细胞毒性T淋巴细胞相关抗原4（伊匹单抗）治疗的患者发生的不良肾脏事件。急性肾损伤发生在治疗开始后的4至12周，具有肾小管间质性肾炎的特征（间质多形性炎性浸润，以CD3 + CD4 + T细胞为主，其中1例伴有肉芽肿）。停用ICI并摄入类固醇后，所有患者的估计肾小球滤过率均有所改善。
这些数据表明，所有ICI都可导致急性间质性肾炎，可能与自身反应性克隆T细胞的存在有关。我们建议接受ICI治疗的患者应在3至6个月内每2周进行一次肾脏监测。
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