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Letter to the Editor| Volume 169, P126-130, July 2022

Immune checkpoint inhibitor associated renally limited thrombotic microangiopathy – a clinical dilemma

Published:May 10, 2022DOI:https://doi.org/10.1016/j.ejca.2022.03.031
Immune checkpoint inhibitor associated renally limited thrombotic microangiopathy – a clinical dilemma
Previous ArticleFDA precedents in drug approvals: Contradiction in promoting more treatment options
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      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 [
      • 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
      ]. 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 [
      • Shruti Gupta
      • Frank B. Cortazar
      • Leonardo V. Riella
      • David E.
      Immune checkpoint inhibitor nephrotoxicity: Update.
      Leaf Kidney. 2020; 360 (January 2020)
      ]. 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.

      Keywords

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      Article info

      Publication history

      Published online: May 10, 2022
      Accepted: March 23, 2022
      Received: March 6, 2022

      Identification

      DOI: https://doi.org/10.1016/j.ejca.2022.03.031

      Copyright

      © 2022 Elsevier Ltd. All rights reserved.

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