Nivolumab and Acute Grade III RenalToxicity

Background: Immune-checkpoint-inhibitors (ICPIs) represent a novel class of immunotherapy against several malignancies that changed the treatment of cancer and improved the patient’s outcome. However these agents are associated with several "immune-mediated" adverse effects, of which, acute kidney injury (AKI) is quite rare. Case report: A 58-year old patient diagnosed with advanced NOS/NSCLC, and not receiving any other medication, experienced a decline in the renal function after four cycles with nivolumab. After ruling out other common causes of interstitial nephritis, was attributed as a cause of interstitial nephritis, confirmed by the renal biopsy. The patient discontinued immunotherapy and he was treated with intravenous prednisolone. There was a slight decrease in creatinine values and he continued treatment at home. Two months later creatinine values had returned to normal, but unfortunately, the patient died from an acute heart attack. Conclusions: AKI is a possible but rare complication of immunotherapy which may require discontinuation of ICPIs and corticosteroid treatment.