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Vol.62 No.3 contents | Japanese/English |
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- Case Report -
A Case of Immune-related Renal Failure in Response to Chemo-immunotherapy Combinations That Was Successfully Treated with Steroid Therapy and Temporary Hemodialysis
Koki Kamada1,2, Naoki Shijubou2,3, Toshiyuki Sumi2,4, Yuichi Yamada4, Hisashi Nakata4, Yuji Mori4, Hirofumi Chiba21Department of Respiratory Medicine, Kushiro City General Hospital, Japan, 2Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Japan, 3Department of Respiratory Medicine, Hakodate Municipal Hospital, Japan, 4Department of Respiratory Medicine, Hakodate Goryoukaku Hospital, Japan
Background. Immune checkpoint inhibitors are the standard of care for non-small cell lung cancer; however, immune-related adverse events have been reported, and appropriate management is important. Immune-related renal failure is one such adverse event. Most patients with immune-related renal failure respond well to steroids. However, some patients develop steroid resistance, and residual renal dysfunction is associated with a worse prognosis. There is no consensus on additional treatment for steroid resistance. Case. The patient was a 72-year-old man diagnosed with cT3N2M0 stage IIIB squamous cell carcinoma of the lung. He had received carboplatin, nab-paclitaxel, and pembrolizumab as initial therapy. The best observed response was a partial response, and he was admitted to the hospital for further investigation because of worsening type 2 diabetes mellitus during the third course of treatment. His blood glucose control was relatively good; however, on the eighth day, he developed increased fatigue and elevated serum creatinine (S-Cr). Although fluid replacement and antimicrobial therapy were started, his renal function worsened. Under the suspicion of immune-related renal failure, steroid therapy was started on the 11th day; however, his renal function did not improve. On the 13th day, hemodialysis (HD) was started. His renal function improved and HD could be withdrawn, with his S-Cr level improving to the baseline level on the 27th day; thereafter, the steroid dosage was tapered. The patient's renal function has not worsened again. Conclusion. We experienced a relatively early onset of immune-related renal failure. Early treatment with steroids and temporary HD may improve a patient's renal function.
key words: Non-small cell lung cancer, Immune checkpoint inhibitors, Immune-related renal failure, Hemodialysis, Steroid pulse therapy
Received: June 14, 2021
Accepted: February 3, 2022
JJLC 62 (3): 221-226, 2022
