• Alexander J Gallan, Ellen Alexander, Pankti Reid, Fouad Kutuby, Anthony Chang, and Kammi J Henriksen.
• Department of Pathology, The University of Chicago, Chicago, IL. Electronic address: alexander.gallan@uchospitals.edu.
• Am. J. Kidney Dis. 2019 Dec 1; 74 (6): 853-856.

AbstractImmune checkpoint inhibitors are increasingly used to treat a variety of solid-organ and hematologic cancers. However, overactivation of the immune system can lead to immune-related adverse events, which are increasingly recognized in the kidney. There have been only rare reported cases of checkpoint inhibitor-associated glomerulonephritis and renal vasculitis, although vasculitis in other organs has been well described. We report 4 cases of renal vasculitis or pauci-immune glomerulonephritis after checkpoint inhibitor therapy. Three patients had renal small- to medium-vessel vasculitis and 1 had focally crescentic pauci-immune glomerulonephritis. Three patients presented with acute kidney injury, and 1 presented with nephrotic syndrome and hematuria. Three patients were tested for antineutrophil cytoplasmic antibodies, which were negative. The time from checkpoint inhibitor initiation to immune-related adverse event presentation ranged from 2 weeks to 24 months. Three patients were treated with glucocorticoids, resulting in clinical resolution. Our series demonstrates that renal vasculitis and pauci-immune glomerulonephritis are important considerations in the differential diagnosis of checkpoint inhibitor-related reductions in kidney function.Copyright © 2019 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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