A common standard option for the treatment of metastatic non-small cell lung cancer (NSCLC) is a combination of platinum-based chemotherapy, pemetrexed, and pembrolizumab [
]. This combination can cause acute kidney injury (AKI) by different mechanisms. Pembrolizumab, one of the immune checkpoint inhibitors (ICIs), is a humanised monoclonal IgG4 antibody directed against programmed cell death 1 which enhances T cell-mediated cancer cell destruction. The most common mechanisms of AKI caused by ICIs are acute interstitial nephritis and sometimes glomerular disorders [
- Gandhi L.
- Rodríguez-Abreu D.
- Gadgeel S.
- Esteban E.
- Felip E.
- De Angelis F.
- Domine M.
- Clingan P.
- Hochmair M.J.
- Powell S.F.
- Cheng S.Y.
- Bischoff H.G.
- Peled N.
- Grossi F.
- Jennens R.R.
- Reck M.
- Hui R.
- Garon E.B.
- Boyer M.
- Rubio-Viqueira B.
- Novello S.
- Kurata T.
- Gray J.E.
- Vida J.
- Wei Z.
- Yang J.
- Raftopoulos H.
- Pietanza M.C.
- Garassino M.C.
KEYNOTE-189 investigators. Pembrolizumab plus chemotherapy in metastatic non-small-cell lung cancer.
N Engl J Med. 2018; 378 (May 31): 2078-2092
]. Hereby, we report a case of Immune Checkpoint Inhibitor Associated Renally Limited Thrombotic Microangiopathy (ICI-rTMA), review the current literature and present the unique dilemma it presents.
- Shruti Gupta
- Frank B. Cortazar
- Leonardo V. Riella
- David E.
Immune checkpoint inhibitor nephrotoxicity: Update.
Leaf Kidney. 2020; 360 (January 2020)
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- KEYNOTE-189 investigators. Pembrolizumab plus chemotherapy in metastatic non-small-cell lung cancer.N Engl J Med. 2018; 378 (May 31): 2078-2092
- Immune checkpoint inhibitor nephrotoxicity: Update.Leaf Kidney. 2020; 360 (January 2020)
- The role of kidney biopsy in Immune Checkpoint Inhibitor-associated AKI. Arash Rashidi, Chintan Shah and Miroslav Sekulic Kidney. January 2022 (360)
- Carboplatin-associated thrombotic microangiopathic hemolytic anemia.Cancer. 1989; 64: 1017-1020
- Thrombotic microangiopathy, cancer, and cancer drugs.Am J Kidney Dis. 2015; 66
- Eculizumab in gemcitabine-induced thrombotic microangiopathy: experience of the French thrombotic microangiopathies reference centre.BMC Nephrol. 2021; 22: 267
- Two cases of carfilzomib-induced thrombotic microangiopathy successfully treated with Eculizumab in multiple myeloma.BMC Nephrol. 2021; 22: 32
- Complement blockade for TA-TMA: lessons learned from a large pediatric cohort treated with eculizumab.Blood. 2020; 135 (Mar 26): 1049-1057
- Eculizumab for transplant-associated thrombotic microangiopathy in adult allogeneic stem cell transplant recipients.Eur J Haematol. 2018; 101: 389-398
- Clinicopathological features of acute kidney injury associated with immune checkpoint inhibitors.Kidney Int. 2016; 90 (Sep): 638-647
- Checkpoint inhibitor therapy-associated acute kidney injury: time to move on to evidence-based recommendations.Clin Kidney J. 2021; 14 (May): 1301-1306
- Acute kidney injury associated with immune checkpoint inhibitor therapy: incidence, risk factors and outcomes.J Immunother Cancer. 2020; 8 (Jun)e000467
- Association of thrombotic microangiopathy with atezolizumab therapy in cancer patients.Eur J Cancer. 2021; 149 (May): 34-36
- Presumed complement-mediated, checkpoint inhibitor-induced, thrombotic microangiopathy in a patient with metastatic melanoma.BMJ Case Rep. 2021; 14 (Jul 26)e242075
- Pembrolizumab-associated thrombotic microangiopathy in a patient with urothelial cancer: a case report and literature review.Ren Replace Ther. 2020; 6: 29
Published online: May 10, 2022
Accepted: March 23, 2022
Received: March 6, 2022
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