SHM Converge Scientific Abstract ePoster Gallery-Not So Friendly Fire: Nivolumab Induced Immune Related Adverse Event

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This case report describes a rare renal immune-related adverse event caused by nivolumab, a PD-1 checkpoint inhibitor used to treat metastatic melanoma. Nivolumab enhances antitumor immunity by blocking PD-1 signaling, but this can also trigger T-cells to attack normal tissues and cause adverse effects in nearly any organ.<br /><br />A 70-year-old man receiving nivolumab presented with nausea and vomiting. He had no urinary symptoms, flank pain, or reduced urine output. His creatinine was markedly elevated at 8.9 mg/dL from a baseline of 0.8 mg/dL. Urinalysis showed mild proteinuria, pyuria, and a few urine eosinophils; renal ultrasound and other studies were unremarkable. He did not improve with IV fluids, raising concern for acute interstitial nephritis (AIN) due to nivolumab.<br /><br />He was treated empirically with high-dose IV methylprednisolone for three days, followed by a prednisone taper. His kidney function improved rapidly, with creatinine decreasing to 5.7 mg/dL before discharge and continuing to improve toward baseline on follow-up.<br /><br />The authors emphasize that while checkpoint inhibitors are generally considered non-nephrotoxic, AIN is an important rare complication. Clinicians should monitor renal function closely in patients on immunotherapy and consider AIN when AKI is accompanied by pyuria, white cell casts, or eosinophiluria, especially when no alternative cause is found. Early recognition and steroid treatment may prevent further kidney injury.

Asset Subtitle

Mikaela Kcomt

Meta Tag

Author List Aung Naing, David Armas, Mikaela Kcomt, Sami Tahhan

Category Clinical Vignettes

Concept Nivolumab

Concept Acute Interstitial Nephritis

Concept PD-1

Concept Immune Checkpoint Inhibitor

Concept Immune-Related Adverse Event

Distinguished Non-Finalist

Presenter Organization Department of Medicine, EVMS at ODU

Presenting Author Mikaela Kcomt

Track Adult

Keywords

nivolumab

acute interstitial nephritis

checkpoint inhibitor

renal adverse event

metastatic melanoma

acute kidney injury

eosinophiluria

pyuria

methylprednisolone

prednisone taper

Nivolumab

Acute Interstitial Nephritis

PD-1

Immune Checkpoint Inhibitor

Immune-Related Adverse Event