Departments of *Internal Medicine †Nephrology ‡Medical Oncology §Pathology, Radboud university medical center, Nijmegen, The Netherlands.
J Immunother. 2017 Nov/Dec;40(9):345-348. doi: 10.1097/CJI.0000000000000189.
Immune checkpoint inhibitors have taken an important place in the treatment of different types of malignancies. These drugs are known to have specific immune-mediated adverse events. We describe a case of severe nephrotic syndrome secondary to treatment with nivolumab in a patient with renal cell carcinoma.
A 62-year-old man was treated with nivolumab for papillary renal cell carcinoma type 2 for 8 weeks when he was admitted to the hospital with a severe nephrotic syndrome and acute kidney injury. Renal biopsy showed focal segmental glomerulosclerosis. Treatment with high-dose corticosteroids had insufficient effect, but the addition of mycophenolate mofetil resulted in remission of the nephrotic syndrome and recovery of renal function. Proteinuria subsequently relapsed during corticosteroid tapering.
The time course in this patient strongly suggests that the nephrotic syndrome occurred as an adverse drug reaction to nivolumab treatment. If during nivolumab treatment renal insufficiency, hypoalbuminemia, or proteinuria develops, further analysis for a possible nephrotic syndrome is warranted for early detection and treatment of this life-threatening complication.
免疫检查点抑制剂在治疗不同类型的恶性肿瘤方面占据了重要地位。这些药物已知具有特定的免疫介导的不良反应。我们描述了一例肾细胞癌患者接受纳武利尤单抗治疗后发生严重肾病综合征的病例。
一名 62 岁男性因肾细胞癌 2 型行纳武利尤单抗治疗 8 周后因严重肾病综合征和急性肾损伤入院。肾活检显示局灶节段性肾小球硬化。尽管给予大剂量皮质类固醇治疗，但效果不佳，但加用霉酚酸酯后肾病综合征缓解，肾功能恢复。随后在逐渐减少皮质类固醇剂量时蛋白尿再次复发。
该患者的发病时间提示肾病综合征是纳武利尤单抗治疗的药物不良反应。如果在纳武利尤单抗治疗期间出现肾功能不全、低白蛋白血症或蛋白尿，应进一步分析是否可能发生肾病综合征，以便早期发现和治疗这种危及生命的并发症。
Zotero 插件