Gordon Lexis, Dokouhaki Pouneh, Hagel Kimberly, Prasad Bhanu
College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Medical Oncology, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada.
BMJ Case Rep. 2019 Oct 25;12(10):e231211. doi: 10.1136/bcr-2019-231211.
Immune checkpoint inhibitors are novel oncological medications, current classes of which include monoclonal antibodies that target inhibitory receptors cytotoxic T lymphocyte-associated antigen 4 (CTLA-4), programmed death 1 protein (PD-1) and programmed death-ligand 1. While they are novel in their ability to treat cancer, they also have a unique spectrum of immune-related adverse events. Renal-related immune adverse events, though rare, are an increasingly recognised clinical entity. We present the case of a 67-year-old man with acute kidney injury (AKI) after the second cycle of combination anti-CTLA-4 and anti-PD-1 antibodies for metastatic cutaneous melanoma. He presented with vomiting and diarrhoea, and AKI secondary to dehydration was treated with aggressive rehydration. After failing to recover biochemically, a renal biopsy was performed, which demonstrated severe acute interstitial nephritis. The culprit medications were held and he was treated with steroids. With immunosuppression, creatinine improved to pretreatment values.
免疫检查点抑制剂是新型肿瘤药物，目前这类药物包括靶向抑制性受体细胞毒性T淋巴细胞相关抗原4（CTLA-4）、程序性死亡1蛋白（PD-1）和程序性死亡配体1的单克隆抗体。虽然它们在治疗癌症方面具有创新性，但也有一系列独特的免疫相关不良事件。肾脏相关的免疫不良事件虽然罕见，但越来越被视为一种临床病症。我们报告了一例67岁男性病例，该患者在接受抗CTLA-4和抗PD-1抗体联合治疗转移性皮肤黑色素瘤的第二个周期后出现急性肾损伤（AKI）。他出现呕吐和腹泻，因脱水继发的AKI通过积极补液进行治疗。生化指标未能恢复正常后，进行了肾活检，结果显示为严重急性间质性肾炎。停用致病药物，并给予类固醇治疗。随着免疫抑制，肌酐水平恢复到治疗前值。
