Hattahara Kodai, Yamasaki Toshinari, Sawada Atsuro, Tanigaki Katsuya, Endo Syuichiro, Teramoto Yuki, Banno Haruka, Fuchigami Yasushi, Suzuki Ryosuke, Fujiwara Maki, Hida Takuya, Yoshino Takayuki, Kita Yuki, Goto Takayuki, Akamatsu Shusuke, Saito Ryoichi, Kobayashi Takashi, Inoue Takahiro, Ogawa Osamu
The Department of Urology, Graduate School of Medicine, Kyoto University.
The Department of Nephrology, Graduate School of Medicine, Kyoto University.
Hinyokika Kiyo. 2019 May;65(5):157-161. doi: 10.14989/ActaUrolJap_65_5_157.
A 43-year-old man underwent nephrectomy for right renal cell carcinoma (cT3aN0M1 (PUL), clear cell carcinoma). Thereafter, he was treated with sunitinib for lung metastases as the first-line therapy for three months. Because lung metastases progressed and new bone metastases appeared, nivolumab was started for the second-line treatment. Although the cancer progression was suppressed by multidisciplinary treatment combined with systemic immunotherapy and local radiation therapy, he developed severe acute kidney injury with cortical swelling after eighteen months of nivolumab treatment. A diagnosis of acute interstitial nephritis induced by nivolumab was made based on biopsy findings. Treatment with prednisolone (1.0 mg/kg daily) led to a rapid improvement in renal function. We must consider the possibility of immunerelated adverse events, especially nivolumab-induced acute kidney injury, even after long-term treatment.
一名43岁男性因右肾细胞癌（cT3aN0M1（肺），透明细胞癌）接受了肾切除术。此后，他接受舒尼替尼治疗肺转移，作为一线治疗持续了三个月。由于肺转移进展且出现了新的骨转移，开始使用纳武单抗进行二线治疗。尽管通过全身免疫治疗和局部放射治疗相结合的多学科治疗抑制了癌症进展，但在纳武单抗治疗18个月后，他出现了严重的急性肾损伤并伴有皮质肿胀。根据活检结果诊断为纳武单抗诱发的急性间质性肾炎。使用泼尼松龙（每日1.0mg/kg）治疗后肾功能迅速改善。即使经过长期治疗，我们也必须考虑免疫相关不良事件的可能性，尤其是纳武单抗诱发的急性肾损伤。
