Department of Nephrology, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-sayama, Osaka, 589-8511, Japan.
Department of Clinical Oncology, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-sayama, Osaka, 589-8511, Japan.
Invest New Drugs. 2018 Aug;36(4):726-731. doi: 10.1007/s10637-018-0596-7. Epub 2018 Apr 6.
We here report a case of nivolumab-induced acute granulomatous tubulointerstitial nephritis in a patient with gastric cancer. A 68-year-old woman with recurrent gastric cancer developed acute kidney injury associated with kidney enlargement and urinary leukocytes after 38 cycles of nivolumab treatment. A diagnosis of acute granulomatous tubulointerstitial nephritis was made based on kidney biopsy findings. Immunohistochemistry revealed expression of programmed cell death-ligand 1 (PD-L1) in degenerated epithelial cells of collecting tubules. Among infiltrating immune cells, aggregation of T cells was more extensive than that of B cells, with CD4 T cells outnumbering CD8 T cells, consistent with the relative numbers of these cells in the circulation. Treatment with methylprednisolone (1.0 mg/kg daily) led to a rapid improvement in renal function and reduction in the number of circulating CD4 T cells. Prompt administration of high-dose corticosteroid is thus recommended after diagnosis of this adverse event of nivolumab treatment by kidney biopsy.
我们在此报告一例纳武利尤单抗引起的胃癌患者急性粒细胞性间质性肾炎。一名 68 岁女性因复发性胃癌，在接受 38 个周期纳武利尤单抗治疗后，出现急性肾损伤、肾脏增大和尿白细胞。根据肾活检结果诊断为急性粒细胞性间质性肾炎。免疫组化显示在集合管的变性上皮细胞中表达程序性死亡配体 1（PD-L1）。在浸润的免疫细胞中，T 细胞聚集比 B 细胞更广泛，CD4 T 细胞多于 CD8 T 细胞，与这些细胞在循环中的相对数量一致。每日 1.0mg/kg 甲泼尼龙治疗导致肾功能迅速改善，循环 CD4 T 细胞数量减少。因此，建议在通过肾活检诊断出纳武利尤单抗治疗的这种不良事件后，立即给予大剂量皮质类固醇治疗。
