Ipilimumab-associated minimal-change disease
2016; Elsevier BV; Volume: 89; Issue: 3 Linguagem: Inglês
10.1016/j.kint.2015.11.028
ISSN1523-1755
AutoresJason M. Kidd, Andinet B. Gizaw,
Tópico(s)Renal Transplantation Outcomes and Treatments
ResumoWe read with great interest the review of new drug toxicities in the onco-nephrology world.1Perazella M.A. Izzedine H. New drug toxicities in the onco-nephrology world.Kidney Int. 2015; 87: 909-917Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar We would like to highlight a case of minimal-change disease and interstitial nephritis related to the use of ipilimumab. This drug has been described as causing acute kidney injury from interstitial nephritis2Thajudeen B. Madhrira M. Bracamonte E. Cranmer L.D. Ipilimumab granulomatous interstitial nephritis.Am J Ther. 2015; 22: e84-e87Crossref PubMed Scopus (55) Google Scholar as well as lupus nephritis3Fadel F, El Karoui K, Knebelmann B. Anti-CTLA4 antibody-induced lupus nephritis. N Engl J Med. 361;2:211–212.Google Scholar in the past, but to our knowledge, there are no reported cases of minimal-change disease related to this anti-CTLA4 drug. Our patient is a 55-year-old male with a history of metastatic melanoma. He presented to the clinic with a 2-week history of lower extremity edema and was found to have acute kidney injury with serum creatinine of 2.97 mg/dl (prior baseline of 1.2 mg/dl). Further work-up revealed 9 g of proteinuria and a serum albumin of 2.2 g/dl. Urine microscopy was unrevealing. He became oliguric, and serum creatinine rose to 5.2 mg/dl. He underwent renal biopsy that showed an interstitium with marked eosinophilic infiltration and severe edema. Glomeruli were unremarkable on light microscopy, but electron microscopy showed diffuse effacement of podocyte foot processes consistent with minimal-change disease (Figure 1). He was treated with high-dose steroids (initially 2 mg/kg). Renal function improved and nephrotic syndrome resolved. One year after this, his serum creatinine was 1.65 mg/dl and he had no proteinuria on urinalysis. This case echoes the recommendation of Perazella et al.1Perazella M.A. Izzedine H. New drug toxicities in the onco-nephrology world.Kidney Int. 2015; 87: 909-917Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar regarding the importance of rapid recognition, early steroid therapy, and renal biopsy to elucidate the cause of acute kidney injury related to this widely used drug. This case was presented as a poster at the American Society of Nephrology annual meeting in November 2015 in San Diego.
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