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Pembrolizumab-induced focal segmental glomerulosclerosis: A case report

RATIONALE: Focal segmental glomerulosclerosis (FSGS) is the most common primary glomerular disorder that leads to end-stage kidney disease. Pembrolizumab, an immune checkpoint inhibitor, is an anti-programmed death 1 (PD-1) immunoglobulin G4 antibody approved for the treatment of advanced melanoma a...

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Autores principales: Kim, Da Woon, Jeon, Hakeong, Kim, Sungmi, Lee, Wanhee, Kim, Hyo Jin, Rhee, Harin, Song, Sang Heon, Seong, Eun Young
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8556051/
https://www.ncbi.nlm.nih.gov/pubmed/34713828
http://dx.doi.org/10.1097/MD.0000000000027546
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author Kim, Da Woon
Jeon, Hakeong
Kim, Sungmi
Lee, Wanhee
Kim, Hyo Jin
Rhee, Harin
Song, Sang Heon
Seong, Eun Young
author_facet Kim, Da Woon
Jeon, Hakeong
Kim, Sungmi
Lee, Wanhee
Kim, Hyo Jin
Rhee, Harin
Song, Sang Heon
Seong, Eun Young
author_sort Kim, Da Woon
collection PubMed
description RATIONALE: Focal segmental glomerulosclerosis (FSGS) is the most common primary glomerular disorder that leads to end-stage kidney disease. Pembrolizumab, an immune checkpoint inhibitor, is an anti-programmed death 1 (PD-1) immunoglobulin G4 antibody approved for the treatment of advanced melanoma and can cause various renal immune-related adverse events (AEs), including acute kidney injury. Several cases of anti PD-1 therapy-induced glomerulonephritis have been reported so far, but FSGS has seldom been reported. PATIENT CONCERNS: 46-year old woman presented to our hospital with generalized edema. DIAGNOSES: Laboratory examination revealed features of nephrotic syndrome, and kidney biopsy confirmed FSGS. After other etiological factors of secondary FSGS were ruled out, she was diagnosed with FSGS caused by pembrolizumab. INTERVENTIONS: She did not resume treatment with pembrolizumab and was treated with irbesartan and furosemide according to the American Society of Clinical Oncology Practice guidelines. OUTCOMES: After 2 months, the features of nephrotic syndrome resolved. LESSONS: This case provides valuable insight into the etiology of FSGS that can occur as a renal immune-related AE of PD-1 inhibitor therapy. Therefore, patients should undergo evaluation for renal function and urinalysis at baseline and after treatment. If patients treated with PD-1 inhibitors present with renal injury and/or unexplained proteinuria >1 g/day, we would recommend a kidney biopsy to determine the underlying cause and establish an appropriate therapeutic plan.
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spelling pubmed-85560512021-11-01 Pembrolizumab-induced focal segmental glomerulosclerosis: A case report Kim, Da Woon Jeon, Hakeong Kim, Sungmi Lee, Wanhee Kim, Hyo Jin Rhee, Harin Song, Sang Heon Seong, Eun Young Medicine (Baltimore) 5200 RATIONALE: Focal segmental glomerulosclerosis (FSGS) is the most common primary glomerular disorder that leads to end-stage kidney disease. Pembrolizumab, an immune checkpoint inhibitor, is an anti-programmed death 1 (PD-1) immunoglobulin G4 antibody approved for the treatment of advanced melanoma and can cause various renal immune-related adverse events (AEs), including acute kidney injury. Several cases of anti PD-1 therapy-induced glomerulonephritis have been reported so far, but FSGS has seldom been reported. PATIENT CONCERNS: 46-year old woman presented to our hospital with generalized edema. DIAGNOSES: Laboratory examination revealed features of nephrotic syndrome, and kidney biopsy confirmed FSGS. After other etiological factors of secondary FSGS were ruled out, she was diagnosed with FSGS caused by pembrolizumab. INTERVENTIONS: She did not resume treatment with pembrolizumab and was treated with irbesartan and furosemide according to the American Society of Clinical Oncology Practice guidelines. OUTCOMES: After 2 months, the features of nephrotic syndrome resolved. LESSONS: This case provides valuable insight into the etiology of FSGS that can occur as a renal immune-related AE of PD-1 inhibitor therapy. Therefore, patients should undergo evaluation for renal function and urinalysis at baseline and after treatment. If patients treated with PD-1 inhibitors present with renal injury and/or unexplained proteinuria >1 g/day, we would recommend a kidney biopsy to determine the underlying cause and establish an appropriate therapeutic plan. Lippincott Williams & Wilkins 2021-10-29 /pmc/articles/PMC8556051/ /pubmed/34713828 http://dx.doi.org/10.1097/MD.0000000000027546 Text en Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0 (https://creativecommons.org/licenses/by/4.0/)
spellingShingle 5200
Kim, Da Woon
Jeon, Hakeong
Kim, Sungmi
Lee, Wanhee
Kim, Hyo Jin
Rhee, Harin
Song, Sang Heon
Seong, Eun Young
Pembrolizumab-induced focal segmental glomerulosclerosis: A case report
title Pembrolizumab-induced focal segmental glomerulosclerosis: A case report
title_full Pembrolizumab-induced focal segmental glomerulosclerosis: A case report
title_fullStr Pembrolizumab-induced focal segmental glomerulosclerosis: A case report
title_full_unstemmed Pembrolizumab-induced focal segmental glomerulosclerosis: A case report
title_short Pembrolizumab-induced focal segmental glomerulosclerosis: A case report
title_sort pembrolizumab-induced focal segmental glomerulosclerosis: a case report
topic 5200
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8556051/
https://www.ncbi.nlm.nih.gov/pubmed/34713828
http://dx.doi.org/10.1097/MD.0000000000027546
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