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Title: Histological diagnosis of immune checkpoint inhibitor induced acute renal injury in patients with metastatic melanoma: a retrospective case series report.
Austin Authors: Hultin, Sebastian;Nahar, Kazi;Menzies, Alexander M;Long, Georgina V;Fernando, Suran L;Atkinson, Victoria;Cebon, Jonathan S ;Wong, Muh Geot
Affiliation: Department of Immunopathology, NSW Health Pathology North, Sydney, Australia
Sydney Medical School, The University of Sydney, Sydney, Australia
Olivia Newton-John Cancer Research Institute
University of Queensland, Brisbane, Australia
Princess Alexandra Hospital, Brisbane, Australia
Department of Medical Oncology, Royal North Shore Hospital and Mater Hospital, Sydney, Australia
Melanoma Institute Australia, The University of Sydney, Sydney, Australia
Westmead Institute of Medical Research, 176 Hawkesbury Road, Westmead, NSW2145, Australia
The George Institute for Global Health, Sydney, Australia
Department of Renal Medicine Royal North Shore Hospital, Sydney, Australia
Issue Date: 7-Sep-2020
Date: 2020-09-07
Publication information: BMC Nephrology 2020; 21(1): 391
Abstract: Immune checkpoint inhibitors (ICI) have become the standard of care in many oncological conditions but are associated with a spectrum of renal immune-related adverse events (IrAEs). We aimed to describe the spectrum, histology, management and outcomes of renal IrAE in patients with metastatic melanoma undergoing ICI therapy. We conducted a retrospective review of 23 patients with a diagnosis of metastatic melanoma treated with ICI between January 2017 and April 2019 who developed a renal IrAE. Baseline demographic data, biochemical and histopathological results, management and outcomes were analyzed. The majority of patients who developed renal irAE were male and received combination immunotherapy. The median time of onset from initiation of ICI therapy to renal IrAE was 4 months. 52% of the treated renal IrAE had histopathologically confirmed renal IrAE. The most common histological pattern of injury was acute tubulo-interstitial nephritis (92%). One patient developed anti-GBM disease with non-dialysis dependent stage 5 CKD. In tubulointerstitial injury, there was no association between peak creatinine, renal recovery and histologically reported inflammation or fibrosis. Patients with renal IrAE demonstrated persisting renal dysfunction at 3, 6 and 12 months with a mean baseline, 3 and 12 month creatinine of 90.0 μmol/L, 127.0 μmol/L and 107.5 μmol/L respectively. Renal IrAE is most commonly attributable to steroid responsive acute tubulointerstitial nephritis. The outcome of rarer pathologies such as anti-GBM disease may be adversely affected by a delayed diagnosis. There is persisting renal dysfunction following an episode of renal IrAE that may have impact on future renal and overall survival outcomes.
DOI: 10.1186/s12882-020-02044-9
ORCID: 0000-0002-6165-3772
Journal: BMC Nephrology
PubMed URL: 32894101
Type: Journal Article
Subjects: AKI
Immune checkpoint inhibitor
Renal biopsy
Tubulo interstitial nephritis
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