Case Report: Successful treatment of late-onset immune checkpoint inhibitor-associated membranous nephropathy in a patient with advanced renal cell carcinoma.
Case Report: Successful treatment of late-onset immune checkpoint inhibitor-associated membranous nephropathy in a patient with advanced renal cell carcinoma.
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DOI：
10.3389/fimmu.2022.898811
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发表时间：
2022
影响因子：
7.3
通讯作者：
Lin, Jamie S.
中科院分区：
文献类型：
--
作者：
Ratanasrimetha, Praveen;Reddy, Vikas D.;Kala, Jaya;Tchakarov, Amanda;Glass, William F.;Msaouel, Pavlos;Lin, Jamie S.
关键词：
诊断免疫检查点抑制剂（ICI）相关肾炎可能具有挑战性，因为它是一种罕见的治疗并发症，与一系列免疫介导的病理学相关，并且可能在ICI治疗停止后数月出现（即，迟发型）。ICI越来越多地与其他具有相关肾毒性的癌症治疗联合给药，进一步混淆了ICI相关肾炎的诊断。在这份报告中，我们描述了第一例迟发性ICI相关膜性肾病（MN）的疑似病例，患者患有转移性透明细胞肾细胞癌（RCC），在就诊前6个月停止ICI治疗。及时识别疑似迟发性免疫相关不良事件（irAE）导致MN的成功治疗和RCC治疗的继续。1例57岁男性转移性透明细胞RCC患者在出现肾病范围蛋白尿和急性肾损伤（阿基）时，对乐伐替尼（口服TKI）和依维莫司（口服mTOR抑制剂）三线RCC治疗有反应。他的肾活检显示可能继发性MN，伴内皮下和系膜免疫复合物沉积，磷脂酶A2受体（PLA2R）和含血小板反应蛋白1型结构域7A（THSD 7A）染色阴性。虽然不能排除副肿瘤性MN的诊断，但患者对癌症治疗有反应，肿瘤消退。然而，在就诊前6个月，患者接受了派姆单抗（一种ICI）和一线RCC治疗。由于担心患者可能出现迟发性ICI相关MN，他接受了利妥昔单抗的有效治疗，这使得他能够继续接受RCC治疗。本报告强调了首例疑似迟发性ICI相关MN病例以及识别肾脏irAE的日益复杂性。随着ICI与其他癌症疗法联合使用的适应症越来越多，认识到ICI免疫性肾炎的各种表现可以帮助指导患者的管理和治疗。
Diagnosing immune checkpoint inhibitor (ICI)-associated nephritis can be challenging since it is a rare complication of therapy, associated with a spectrum of immune-mediated pathologies, and can present months after ICI therapy discontinuation (i.e., late-onset). ICIs are increasingly administered in combination with other cancer therapies with associated nephrotoxicity, further obfuscating the diagnosis of ICI-associated nephritis. In this report, we describe the first suspected case of late-onset ICI-associated membranous nephropathy (MN) in a patient with metastatic clear cell renal cell carcinoma (RCC) who had discontinued ICI therapy 6 months prior to presentation. Prompt recognition of the suspected late-onset immune-related adverse event (irAE) resulted in the successful treatment of MN and continuation of RCC therapy. A 57-year-old man with metastatic clear cell RCC was responsive to third-line RCC therapy with lenvatinib (oral TKI) and everolimus (oral mTOR inhibitor) when he presented with nephrotic range proteinuria and acute kidney injury (AKI). His kidney biopsy revealed probable secondary MN with subendothelial and mesangial immune complex deposits and negative staining for both phospholipase A2 receptor (PLA2R) and thrombospondin type-1 domain-containing 7A (THSD7A). While a diagnosis of paraneoplastic MN could not be excluded, the patient was responding to cancer therapy and had tumor regression. However, 6 months prior to presentation, the patient had received pembrolizumab, an ICI, with his first-line RCC treatment. Due to concern that the patient may be presenting with late-onset ICI-associated MN, he was effectively treated with rituximab, which allowed for his continued RCC therapy. This report highlights the first case of suspected late-onset ICI-associated MN and the increasing complexity of recognizing renal irAEs. With the growing indications for the use of ICIs in combination with other cancer therapies, recognizing the various presentations of ICI-immune nephritis can help guide patient management and treatment.
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影响因子：
19.6
作者：
Cortazar FB;Marrone KA;Troxell ML;Ralto KM;Hoenig MP;Brahmer JR;Le DT;Lipson EJ;Glezerman IG;Wolchok J;Cornell LD;Feldman P;Stokes MB;Zapata SA;Hodi FS;Ott PA;Yamashita M;Leaf DE
通讯作者：
Leaf DE
DOI：
10.1186/cc11454
发表时间：
2013-02-04
期刊：
Critical care (London, England)
影响因子：
--
作者：
Kellum JA;Lameire N;KDIGO AKI Guideline Work Group
通讯作者：
KDIGO AKI Guideline Work Group
影响因子：
8.8
作者：
Grunwald, Viktor;Voss, Martin H.;Jonasch, Eric
通讯作者：
Jonasch, Eric
影响因子：
158.5
作者：
Eremina, Vera;Jefferson, J. Ashley;Quaggin, Susan E.
通讯作者：
Quaggin, Susan E.
影响因子：
10.9
作者：
Mamlouk, Omar;Selamet, Umut;Abudayyeh, Ala
通讯作者：
Abudayyeh, Ala