Pembrolizumab-Induced Anti-GBM Glomerulonephritis: A Case Report

Abstract

Immune checkpoint inhibitors are known to have a wide range of autoimmune toxicities, such as acute interstitial nephritis. Immunotherapy induced glomerulonephritis has been described, but anti-glomerular basement membrane disease (anti-GBM) is rarely reported. We present a case report of a 60-year-old woman with squamous cell carcinoma of the cervix who was treated with pembrolizumab, an anti-programmed cell death protein 1, and who developed severe acute kidney injury 4 months after therapy initiation. The immune workup showed a positive serum anti-GBM antibody (24 U/mL). The kidney biopsy showed crescentic glomerulonephritis with linear immunoglobulin G2 glomerular basement membrane staining, compatible with anti-GBM glomerulonephritis. The patient was treated with plasmapheresis, IV steroids, and cyclophosphamide, but she developed kidney failure, necessitating dialysis. Few case reports, such as the present case, provide a possible link between anti-GBM glomerulonephritis and immune checkpoint inhibitors, warranting early clinical suspicion and investigation in patients who are treated with these agents and subsequently develop acute kidney injury.

Keywords: Immunotherapy; acute kidney injury; anti- GBM; cancer; checkpoint inhibitors; glomerulonephritis; kidney failure.

Figure 1

Kidney biopsy. (A) The upper panel (Masson’s Trichrome stain) shows glomeruli with fibrin-rich cellular crescents (blue arrows) and fibrinoid material in the lumen of a periglomerular arteriole (black arrow). (B) The lower panel shows immunoglobulin G immunofluorescence with linear glomerular basement membrane staining.