SHM Converge Scientific Abstract ePoster Gallery-Melanoma Treatment-Related Acute Interstitial Nephritis

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This case report describes a 73-year-old man with metastatic melanoma who developed severe acute kidney injury after sequential exposure to immune checkpoint inhibitor (ICI) therapy and BRAF/MEK targeted therapy. He first received one dose of nivolumab plus ipilimumab, then was switched to dabrafenib and trametinib after BRAF V600E mutation testing was positive. Within a week of starting the targeted therapy, he developed fevers and diarrhea that progressed over a month to hospitalization with creatinine 6.3 mg/dL, thrombocytopenia, coagulopathy, and possible sepsis, DIC, or tumor lysis syndrome.<br /><br />He was treated with antibiotics, then required continuous renal replacement therapy and high-dose IV methylprednisolone. Cultures were negative, renal function improved, dialysis was stopped, and kidney biopsy showed acute interstitial nephritis (AIN) with interstitial inflammation, tubular injury, and pigment consistent with melanin. He was discharged on a prednisone taper.<br /><br />The authors note that although ICI-related kidney toxicity is better recognized, biopsy-proven cases remain uncommon, and renal injury from dabrafenib/trametinib is also rarely confirmed by biopsy. Because both drug classes can cause fever and AKI, identifying the exact culprit is difficult in this patient. However, the case highlights that AIN may be underreported with either therapy.<br /><br />Key takeaways include: consider kidney biopsy in patients who develop AKI after ICI or BRAF/MEK therapy; manage suspected AIN by stopping the offending drug and starting steroids; and, if needed, ICI rechallenge after recovery may be reasonable, though data on restarting BRAF/MEK therapy after severe kidney injury are limited.

Asset Subtitle

McKenna Johnson

Meta Tag

Author List Anatoly Urisman, Brittany McManaman, McKenna Johnson

Category Clinical Vignettes

Concept Melanoma

Concept Immune Checkpoint Inhibitor

Concept Acute Kidney Injury

Concept Acute Interstitial Nephritis

Concept BRAF V600 Mutation

Distinguished Non-Finalist

Presenter Organization Ucsd

Presenting Author McKenna Johnson

Track Adult

Keywords

metastatic melanoma

acute kidney injury

immune checkpoint inhibitor

nivolumab ipilimumab

dabrafenib trametinib

acute interstitial nephritis

kidney biopsy

high-dose corticosteroids

BRAF V600E mutation

renal toxicity

Melanoma

Immune Checkpoint Inhibitor

Acute Kidney Injury

Acute Interstitial Nephritis

BRAF V600 Mutation