Open AccessPembrolizumab-induced focal segmental glomerulosclerosis
Author(s) -
Da-Woon Kim,
Hakeong Jeon,
Sung-Mi Kim,
Wanhee Lee,
Hyo Jin Kim,
Harin Rhee,
Sang Heon Song,
Eun Young Seong
Publication year - 2021
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000027546
Subject(s) - medicine , focal segmental glomerulosclerosis , nephrotic syndrome , pembrolizumab , acute kidney injury , acute tubular necrosis , renal function , dialysis , renal biopsy , proteinuria , kidney disease , nephrology , gastroenterology , pathology , kidney , cancer , immunotherapy
Rationale: Focal segmental glomerulosclerosis (FSGS) is the most common primary glomerular disorder that leads to end-stage kidney disease. Pembrolizumab, an immune checkpoint inhibitor, is an anti-programmed death 1 (PD-1) immunoglobulin G4 antibody approved for the treatment of advanced melanoma and can cause various renal immune-related adverse events (AEs), including acute kidney injury. Several cases of anti PD-1 therapy-induced glomerulonephritis have been reported so far, but FSGS has seldom been reported. Patient concerns: 46-year old woman presented to our hospital with generalized edema. Diagnoses: Laboratory examination revealed features of nephrotic syndrome, and kidney biopsy confirmed FSGS. After other etiological factors of secondary FSGS were ruled out, she was diagnosed with FSGS caused by pembrolizumab. Interventions: She did not resume treatment with pembrolizumab and was treated with irbesartan and furosemide according to the American Society of Clinical Oncology Practice guidelines. Outcomes: After 2 months, the features of nephrotic syndrome resolved. Lessons: This case provides valuable insight into the etiology of FSGS that can occur as a renal immune-related AE of PD-1 inhibitor therapy. Therefore, patients should undergo evaluation for renal function and urinalysis at baseline and after treatment. If patients treated with PD-1 inhibitors present with renal injury and/or unexplained proteinuria >1 g/day, we would recommend a kidney biopsy to determine the underlying cause and establish an appropriate therapeutic plan.