Published in:
01-08-2018 | SHORT REPORT
Nivolumab-induced acute granulomatous tubulointerstitial nephritis in a patient with gastric cancer
Authors:
Yoshihisa Nakatani, Hisato Kawakami, Masashi Ichikawa, Sachiyo Yamamoto, Yasuo Otsuka, Akiko Mashiko, Yasutoshi Takashima, Akihiko Ito, Kazuhiko Nakagawa, Shuji Arima
Published in:
Investigational New Drugs
|
Issue 4/2018
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Summary
We here report a case of nivolumab-induced acute granulomatous tubulointerstitial nephritis in a patient with gastric cancer. A 68-year-old woman with recurrent gastric cancer developed acute kidney injury associated with kidney enlargement and urinary leukocytes after 38 cycles of nivolumab treatment. A diagnosis of acute granulomatous tubulointerstitial nephritis was made based on kidney biopsy findings. Immunohistochemistry revealed expression of programmed cell death–ligand 1 (PD-L1) in degenerated epithelial cells of collecting tubules. Among infiltrating immune cells, aggregation of T cells was more extensive than that of B cells, with CD4+ T cells outnumbering CD8+ T cells, consistent with the relative numbers of these cells in the circulation. Treatment with methylprednisolone (1.0 mg/kg daily) led to a rapid improvement in renal function and reduction in the number of circulating CD4+ T cells. Prompt administration of high-dose corticosteroid is thus recommended after diagnosis of this adverse event of nivolumab treatment by kidney biopsy.