Characteristics and outcomes of patients with checkpoint inhibitor-related vasculitis with kidney involvement
| Case ref. | Malignancy | CPI other AIN-associated med. | AKI Cr, mg/dL other IrAEs | Biopsy and classification | Extra renal MANIF. | ANCA | Treatment | Renal outcome | PFS cancer status |
| Case 1 | Non-small cell lung cancer | Nivolumab Ibuprofen | 1 to 4.52 Hematuria Thyroiditis | Focal crescentic glomerulonephritis and focal global glomerulosclerosis No arteritis | – | Negative | Corticosteroid and rituximab | Complete recovery of renal function Persistent hematuria | 4 months Patient died |
| Case 2 | Renal cell carcinoma | Tremelimumab Amoxicillin | 1.8 to 4.75 Hematuria Dermatitis | Focal crescentic glomerulonephritis and focal global glomerulosclerosis No arteritis AIN | Lungs | MPO + | Corticosteroid, plasmapheresis and rituximab | Partial recovery of renal function (Cr 2.8 mg/dL) Resolution of hematuria No relapse | 12 months On tyrosine kinase inhibitor |
| Case 3 | Melanoma | Nivolumab+ipilimumab Omeprazole | 1.4 to 4.9 Hematuria Dermatitis Thyroiditis Adrenal insufficiency | Diffuse global glomerulosclerosis Granuloma No crescents Arteritis | – | Negative | Corticosteroid and rituximab | Complete recovery of renal function Resolution of hematuria | 8 months Patent died |
| Case 4 | Liposarcoma | Nivolumab Pantoprazole | 1 to 7.5* Hematuria | Focal crescentic glomerulonephritis and focal global glomerulosclerosis No arteritis | – | Negative | Corticosteroid, plasmapheresis and rituximab | Partial recovery of renal function (Cr 1.7 mg/dL) Persistent microscopic hematuria No relapse | – |
| Case 5 | Melanoma | Nivolumab+ipilimumab Pantoprazole | 0.9 to 6.8* Hematuria Proteinuria Hepatitis | Diffuse crescentic glomerulonephritis No glomerular sclerosis No arteritis, mild AIN | Skin | Negative | Corticosteroid, plasmapheresis and rituximab | Partial recovery of renal function (Cr 2.6 mg/dL) Persistent microscopic hematuria | 4 months No progression |
| van den Brom et al 4 | Melanoma | Ipilimumab followed by pembrolizumab | – Hematuria | GPA No kidney biopsy | Skin and lungs | PR3 + | Corticosteroid and ciclosporin | Symptoms resolution | Not stated |
| Ina Cusnir and Yacyshyn3 | Melanoma | Nivolumab+ipilimumab | – Hematuria | GPA Focal proliferative glomerulonephritis | Skin and lungs | PR3 + | Corticosteroid Rituximab | Not stated | Not stated |
| Person et al 6 | Melanoma | Nivolumab+ipilimumab | Severe AKI* Pyuria | TMA Vasculitis Granuloma | Skin and lungs | – | Corticosteroid, mycophenolic acid and TNF-alpha blocker | No renal recovery | Progressive disease |
| Gallan et al case 15 | Melanoma | Nivolumab | 1 to 1.7 Hypophysitis | Focal global glomerulosclerosis No crescents Arteritis | Lungs | – | Not treated | – | Deceased |
| Gallan et al case 2 | Adenocarcinoma of the lung | Pembrolizumab | No AKI Hematuria proteinuria | Focal global glomerulosclerosis Focal crescentic glomerulonephritis No arteritis | Skin | Negative | Corticosteroid | Resolution of hematuria and proteinuria | Not stated |
| Gallan et al case 3 | Non-small lung cancer | Nivolumab | 1.1 to 6.1* Hematuria and pyuria | Focal global glomerulosclerosis No crescent Arteritis and AIN | Not reported | Negative | Corticosteroid | Partial recovery (Cr 2 mg/dL) | Not stated |
| Gallan et al case 4 | Melanoma | Nivolumab | 1.5 to 5.5 | No glomerular crescent or sclerosis Arteritis and AIN | Not reported | Negative | Corticosteroid | Complete recovery (Cr 1.2 mg/dL) | Not stated |
Pembrolizumab and nivolumab are programmed cell death protein 1 inhibitors. Ipilimumab and tremelimumab are cytotoxic T-lymphocyte-associated protein 4 inhibitors.
*Required renal replacement therapy at diagnosis.
AIN, acute interstitial nephritis; AKI, acute kidney injury; ANCA, antineutrophil cytoplasmic antibodies; CPI, checkpoint inhibitor; Cr, creatinine; GPA, granulomatosis with polyangiitis ; IrAEs, immune-related adverse events; MANIF., manifestation; med., medication; MPO, myeloperoxidase; PFS, progression-free survival; PR3, proteinase 3; TMA, thrombotic microangiopathy; TNF, tumor necrosis factor.