SHM Converge Scientific Abstract ePoster Gallery-A Rare Renal Risk: Nivolumab-Induced Nephrotic Syndrome During Mesothelioma Treatment

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This case report describes a rare instance of nivolumab-induced nephrotic syndrome in an 82-year-old man with recurrent primary epithelial mesothelioma related to asbestos exposure. After prior treatment with carboplatin/pemetrexed, surgery, and later palliative nivolumab, the patient developed dyspnea and bilateral leg edema after cycle 3. Examination showed hypertension and anasarca. Laboratory testing revealed acute renal dysfunction (creatinine 3.27 mg/dL), severe hypoalbuminemia (albumin 2.1 mg/dL), and heavy proteinuria (10 g), raising concern for nephrotic syndrome.<br /><br />Nivolumab is an IgG4 monoclonal antibody that blocks PD-1 on T-cells and can trigger autoimmune toxicities by disrupting immune self-tolerance. Renal adverse effects from immune checkpoint inhibitors are uncommon, with an incidence of about 2–5%, but can include acute tubulointerstitial nephritis, immune complex glomerulonephritis, thrombotic microangiopathy, and, rarely, nephrotic syndrome. In this case, PET/CT showed good tumor response to nivolumab, but the patient required hospital admission for close nephrology and oncology follow-up, along with oral corticosteroids and IV diuretics. Kidney biopsy demonstrated diffuse foot process effacement, consistent with immune-mediated nephropathy.<br /><br />The report highlights that nephrotic syndrome is a serious but rare potential complication of nivolumab, especially in patients receiving PD-1 inhibitors who develop renal insufficiency, proteinuria, hypoalbuminemia, or edema. Early recognition is important because treatment typically includes corticosteroids to reduce immune-mediated glomerular injury and diuretics to manage fluid overload.

Asset Subtitle

Emily D. Wang

Meta Tag

Author List Christian Fang, Emily D. Wang, Heet Patel, Jiexi Hu, Waina Cheng

Category Clinical Vignettes

Concept Nivolumab

Concept Immune-Mediated Renal Toxicity

Concept Nephrotic Syndrome

Concept PD-1 Inhibitor

Concept Proteinuria

Distinguished Non-Finalist

Presenter Organization Rowan-Virtua School of Osteopathic Medicine

Presenting Author Emily D. Wang

Track Adult

Keywords

nivolumab

nephrotic syndrome

mesothelioma

immune checkpoint inhibitor

proteinuria

hypoalbuminemia

acute renal dysfunction

corticosteroids

PD-1 inhibitor

kidney biopsy

Nivolumab

Immune-Mediated Renal Toxicity

Nephrotic Syndrome

PD-1 Inhibitor

Proteinuria