Ishii Makoto, Takezawa Kentaro, Imamura Ryoichi, Fukuhara Shinichiro, Fujita Kazutoshi, Uemura Motohide, Kiuchi Hiroshi, Nonomura Norio
Department of Urology, Osaka University Graduate School of Medicine.
Nihon Hinyokika Gakkai Zasshi. 2021;112(2):109-112. doi: 10.5980/jpnjurol.112.109.
The patient was 74-year-old woman. She underwent open nephrectomy for right kidney cancer with multiple lung metastasis in June X, and was diagnosed as clear cell renal cell carcinoma, pT3bN0M1. Combination therapy with ipilimumab and nivolumab was started in July X. In September X, she presented our hospital with the chief complaint of anorexia. The renal function deteriorated remarkably with serum Cr of 8.58 mg/dL and BUN of 71 mg/dL. CT scan revealed an enlarged left kidney at that time. She was clinically diagnosed as Grade 3 interstitial nephritis caused by immune checkpoint inhibitor, and treatment was initiated immediately. She was treated with steroid therapy and discontinuation of the drugs she was taking, which gradually improved her renal function, and brought it back to baseline in three weeks. After that, the steroid was carefully tapered, and turned off on day 52, and nivolumab monotherapy was resumed on day 60. After five cycles of nivolumab monotherapy, there has been no recurrence of interstitial nephritis, and the disease remains stable. In Japan, 38 cases of interstitial nephritis due to immune checkpoint inhibitors have been reported. In most cases, the diagnosis was made by histological examination; however, we believe that the diagnosis should be made clinically and treatment should be started immediately, since the early treatment is important for immune-related adverse events.
该患者为一名74岁女性。她于X月接受了开放性肾切除术，以治疗患有多发肺转移的右肾癌，病理诊断为透明细胞肾细胞癌，pT3bN0M1。X月开始使用伊匹单抗和纳武单抗联合治疗。X月，她因食欲不振为主诉前来我院就诊。肾功能显著恶化，血清肌酐为8.58mg/dL，尿素氮为71mg/dL。当时的CT扫描显示左肾增大。她被临床诊断为免疫检查点抑制剂引起的3级间质性肾炎，并立即开始治疗。她接受了类固醇治疗，并停用了正在服用的药物，肾功能逐渐改善，并在三周内恢复到基线水平。此后，类固醇逐渐减量，在第52天停药，第60天恢复纳武单抗单药治疗。经过五个周期的纳武单抗单药治疗，间质性肾炎未复发，病情保持稳定。在日本，已有38例因免疫检查点抑制剂引起间质性肾炎的病例报道。在大多数情况下，诊断是通过组织学检查做出的；然而，我们认为应进行临床诊断并立即开始治疗，因为早期治疗对免疫相关不良事件很重要。
