Department of Renal Medicine Royal North Shore Hospital, Sydney, Australia.
Sydney Medical School, The University of Sydney, Sydney, Australia.
BMC Nephrol. 2020 Sep 7;21(1):391. doi: 10.1186/s12882-020-02044-9.
Immune checkpoint inhibitors (ICI) have become the standard of care in many oncological conditions but are associated with a spectrum of renal immune-related adverse events (IrAEs). We aimed to describe the spectrum, histology, management and outcomes of renal IrAE in patients with metastatic melanoma undergoing ICI therapy.
We conducted a retrospective review of 23 patients with a diagnosis of metastatic melanoma treated with ICI between January 2017 and April 2019 who developed a renal IrAE. Baseline demographic data, biochemical and histopathological results, management and outcomes were analyzed.
The majority of patients who developed renal irAE were male and received combination immunotherapy. The median time of onset from initiation of ICI therapy to renal IrAE was 4 months. 52% of the treated renal IrAE had histopathologically confirmed renal IrAE. The most common histological pattern of injury was acute tubulo-interstitial nephritis (92%). One patient developed anti-GBM disease with non-dialysis dependent stage 5 CKD. In tubulointerstitial injury, there was no association between peak creatinine, renal recovery and histologically reported inflammation or fibrosis. Patients with renal IrAE demonstrated persisting renal dysfunction at 3, 6 and 12 months with a mean baseline, 3 and 12 month creatinine of 90.0 μmol/L, 127.0 μmol/L and 107.5 μmol/L respectively.
Renal IrAE is most commonly attributable to steroid responsive acute tubulointerstitial nephritis. The outcome of rarer pathologies such as anti-GBM disease may be adversely affected by a delayed diagnosis. There is persisting renal dysfunction following an episode of renal IrAE that may have impact on future renal and overall survival outcomes.
免疫检查点抑制剂（ICI）已成为许多肿瘤学疾病的标准治疗方法，但与一系列肾脏免疫相关不良事件（IrAE）有关。我们旨在描述接受 ICI 治疗的转移性黑色素瘤患者的肾脏 IrAE 的谱、组织学、管理和结局。
我们对 2017 年 1 月至 2019 年 4 月期间接受 ICI 治疗并发生肾脏 IrAE 的 23 例转移性黑色素瘤患者进行了回顾性分析。分析了基线人口统计学数据、生化和组织病理学结果、治疗和结局。
大多数发生肾脏 irAE 的患者为男性，并接受了联合免疫治疗。ICI 治疗开始至肾脏 IrAE 发病的中位时间为 4 个月。52%的治疗肾脏 IrAE 经组织病理学证实为肾脏 IrAE。最常见的损伤组织学模式是急性肾小管间质性肾炎（92%）。1 例患者发生抗肾小球基底膜病，伴非透析依赖的 5 期 CKD。在肾小管间质损伤中，峰值肌酐、肾脏恢复与组织学报告的炎症或纤维化之间无关联。肾脏 IrAE 患者在 3、6 和 12 个月时仍存在肾功能障碍，平均基线、3 个月和 12 个月时的肌酐分别为 90.0 μmol/L、127.0 μmol/L 和 107.5 μmol/L。
肾脏 IrAE 最常见于激素反应性急性肾小管间质性肾炎。抗肾小球基底膜病等罕见病理的结局可能因诊断延迟而受到不利影响。肾脏 IrAE 发作后存在持续的肾功能障碍，可能对未来的肾脏和总体生存结局产生影响。
