Nivolumab-induced acute tubular injury: A case report

Nivolumab belongs to immune checkpoint inhibitors (ICIs). ICIs-induced kidney injury is rare and acute interstitial nephritis (AIN) is the majority. A 58-year-old woman had gastric cancer treated with nivolumab. Her serum creatinine (Cr) increased to 5.94 mg/dL post 2 cycles of nivolumab and co-administered with acemetacin. A kidney biopsy showed acute tubular injury (ATI). Nivolumab rechallenge was done and Cr worsened again. The lymphocyte transformation test (LTT) indicated a strong positive for nivolumab. Although rare, ATI due to ICIs could not be ruled out, and LTT is a tool to identify the culprit.

Automated summary

Nivolumab, an immune checkpoint inhibitor (ICI), can rarely cause kidney injury, with acute interstitial nephritis (AIN) being the most common form. A 58-year-old woman with gastric cancer developed an increase in serum creatinine (Cr) to 5.94 mg/dL after 2 cycles of nivolumab and co-administration of acemetacin. A kidney biopsy revealed acute tubular injury (ATI). Nivolumab rechallenge resulted in further worsening of Cr, and lymphocyte transformation test (LTT) showed a strong positive for nivolumab. Although rare, ATI caused by ICIs cannot be ruled out, and LTT is a useful tool to identify the responsible agent.