Matsumura Yoshiaki, Iemura Yusuke, Fukui Shinji, Tatsumi Yoshihiro, Kagebayashi Yoriaki, Samma Shoji
Department of Urology Nara Prefecture General Medical Center Nara Japan.
IJU Case Rep. 2019 Apr 10;2(3):155-157. doi: 10.1002/iju5.12067. eCollection 2019 May.
The efficacy and safety of nivolumab for patients receiving hemodialysis remain uncertain. Herein, we report a patient receiving a maintenance hemodialysis with life-threatening interstitial pneumonitis caused by nivolumab for metastatic renal cell carcinoma.
A 61-year-old man with chronic kidney disease after nephrectomy for renal cell carcinoma was started on hemodialysis. Six months later, he developed multiple bone metastases and received pazopanib. Pazopanib, however, was not effective. We then switched to nivolumab as second-line treatment. Five days after the first administration of nivolumab, he complained of respiratory discomfort and malaise with oxygen desaturation. Chest computed tomography demonstrated diffuse areas of ground glass opacity in both lung fields, suggesting programmed cell death 1 inhibitor-related pneumonitis. Prompt corticosteroid therapy led to improvement of the symptoms.
Caution should be exercised on the administration of nivolumab to hemodialysis patients due to the risk of interstitial pneumonitis.
纳武单抗用于接受血液透析患者的疗效和安全性仍不确定。在此，我们报告一例接受维持性血液透析的患者，其因纳武单抗治疗转移性肾细胞癌而发生危及生命的间质性肺炎。
一名61岁男性，因肾细胞癌肾切除术后患有慢性肾脏病，开始接受血液透析。六个月后，他出现多处骨转移并接受了帕唑帕尼治疗。然而，帕唑帕尼无效。然后我们改用纳武单抗作为二线治疗。首次使用纳武单抗五天后，他主诉呼吸不适和全身乏力伴氧饱和度下降。胸部计算机断层扫描显示双肺野弥漫性磨玻璃影，提示程序性细胞死亡蛋白1抑制剂相关性肺炎。及时给予糖皮质激素治疗后症状改善。
由于存在间质性肺炎风险，在给血液透析患者使用纳武单抗时应谨慎。
