Zhao Jian-Hui, Wang Jing-Jiao, Li Yi-Wen
Department of Nephrology, Xinchang County People's Hospital, Xinchang 312500, Zhejiang Province, China.
Department of Medical Oncology, Xinchang County People's Hospital, Shaoxing 312500, Zhejiang Province, China.
World J Clin Cases. 2025 May 26;13(15):103239. doi: 10.12998/wjcc.v13.i15.103239.
Immune checkpoint inhibitors (ICIs) are a new class of antitumor agents. They enhance antitumor effects by blocking inhibitory receptors and related ligands expressed on T cells. ICIs also modulate regular immune cell activity, affecting the immune system and causing immune-related adverse events. The renal system is sometimes affected by these adverse events. Currently, the literature on ICIs-related glomerular injuries is scarce.
We present a patient who developed granulomatosis with polyangiitis (GPA) 3 weeks after treatment with the anti-programmed cell death-1 inhibitor, tislelizumab. The patient experienced proteinuria, hematuria, and acute kidney injury without pulmonary hemorrhage and tested positive for anti-neutrophil cytoplasmic antibody (ANCA)-cytoplasmic type. Renal biopsy confirmed ANCA-associated vasculitis, and GPA was finally diagnosed. The patient received pulse treatment with glucocorticoids and cyclophosphamide, and renal function improved. After self-discontinuation of the drug, the disease recurred, and the original treatment regimen was continued. However, the patient's renal function continued to deteriorate.
Glucocorticoids plus cyclophosphamide are effective for treating GPA induced by tislelizumab. However, follow-up and patient education are needed.
免疫检查点抑制剂（ICIs）是一类新型抗肿瘤药物。它们通过阻断T细胞上表达的抑制性受体和相关配体来增强抗肿瘤作用。ICIs还调节正常免疫细胞活性，影响免疫系统并导致免疫相关不良事件。肾脏系统有时会受到这些不良事件的影响。目前，关于ICIs相关肾小球损伤的文献较少。
我们报告一名患者，在用抗程序性细胞死亡蛋白1抑制剂替雷利珠单抗治疗3周后发生肉芽肿性多血管炎（GPA）。患者出现蛋白尿、血尿和急性肾损伤，无肺出血，抗中性粒细胞胞浆抗体（ANCA）胞浆型检测呈阳性。肾活检证实为ANCA相关性血管炎，最终诊断为GPA。患者接受了糖皮质激素和环磷酰胺的冲击治疗，肾功能得到改善。自行停药后，疾病复发，继续原治疗方案。然而，患者的肾功能继续恶化。
糖皮质激素加环磷酰胺对治疗替雷利珠单抗诱导的GPA有效。然而，需要进行随访和患者教育。
