Department of Nephrology, Chubu Rosai Hospital, Japan.
Department of Rheumatology, Chubu Rosai Hospital, Japan.
Intern Med. 2024 Jan 15;63(2):265-270. doi: 10.2169/internalmedicine.1640-23. Epub 2023 May 31.
A Japanese woman in her 60s developed a kidney injury 9 weeks after treatment with pemetrexed, carboplatin, and pembrolizumab for stage IV lung adenocarcinoma. A renal biopsy showed chronic tubulointerstitial damage with minimal focal interstitial inflammation, consistent with pemetrexed-induced nephropathy; thus, pemetrexed was withdrawn. However, the kidney injury continued to worsen. A repeated biopsy showed severe acute tubulointerstitial nephritis, suggestive of a pembrolizumab-induced immune-related adverse event (irAE). The worsening after pemetrexed discontinuation suggested that the irAE had already begun, as the first biopsy showed focal inflammation. This case suggests thatcombining immune checkpoints and chemotherapy requires considering concurrent drug-induced nephrotoxicity.
一位 60 多岁的日本女性在接受培美曲塞、卡铂和帕博利珠单抗治疗 IV 期肺腺癌 9 周后出现肾损伤。肾活检显示慢性肾小管间质性损伤，伴有最小程度的局灶性间质炎症，符合培美曲塞引起的肾损伤；因此，停用培美曲塞。然而，肾损伤持续恶化。重复肾活检显示严重的急性肾小管间质性肾炎，提示为帕博利珠单抗引起的免疫相关不良事件（irAE）。培美曲塞停药后病情恶化提示 irAE 已经开始，因为第一次活检显示局灶性炎症。本病例提示联合免疫检查点抑制剂和化疗时需要考虑药物相关性肾毒性。
