Renal toxicities associated with pembrolizumab

Hassan Izzedine, Alexis Mathian, Stephane Champiat, Cécile Picard, Christine Mateus, Emilie Routier, Andrea Varga, David Malka, Alexandra Leary, Judith Michels, Jean Marie Michot, Aurélien Marabelle, Olivier Lambotte, Zahir Amoura, Jean Charles Soria, Sihem Kaaki, Nathalie Quellard, Jean Michel Goujon, Isabelle Brocheriou

Research output: Contribution to journalArticlepeer-review

85 Scopus citations


Objective Expanded clinical experience with patients treated by pembrolizumab has accumulated. However, renal toxicities associated with this anti-programmed cell death 1 agent are poorly described because kidney histology is rarely sought. As a nephrology referral centre, we aimed to describe the clinic-biological and histopathological characteristics of pembrolizumab-related nephropathy and its response to treatment. Methods We conducted a monocentric large case series study, including all pembrolizumab-treated cancer patients presenting a renal toxicity addressed to our centre from 2015 to 2017. Results A total of 12 patients (7 men) out of 676 pembrolizumab-treated patients (incidence 1.77%) were included (median age 69.75 years). Patients were referred for acute kidney injury (n = 10) and/or proteinuria (n = 2). A kidney biopsy was performed in all patients, with a median duration of use of 9 months (range 1-24 months) after the beginning of treatment. Biopsy showed that four patients had acute interstitial nephritis (AIN), whereas five had acute tubular injury (ATI) alone, one had minimal change disease (MCD) and ATI, and one had MCD alone. Pembrolizumab withdrawal coupled with corticosteroid therapy was the most effective treatment for kidney function recovery. Drug reintroduction resulted in a more severe recurrence of AIN in one patient who required maintenance of pembrolizumab. Two patients died of cancer progression with one of them developing severe renal failure requiring dialysis. Conclusion In our series, ATI, AIN and MCD are the most frequent forms of kidney involvement under pembrolizumab therapy. Kidney dysfunction is usually isolated but can be severe. Use of corticosteroids in case of AIN improves the glomerular filtration rate.

Original languageEnglish
Pages (from-to)81-88
Number of pages8
JournalCKJ: Clinical Kidney Journal
Issue number1
StatePublished - 1 Feb 2019
Externally publishedYes

Bibliographical note

Publisher Copyright:
© The Author(s) 2018. Published by Oxford University Press on behalf of ERA-EDTA.


  • acute interstitial nephritis
  • acute kidney injury
  • acute tubular injury
  • minimal change nephropathy
  • pembrolizumab


Dive into the research topics of 'Renal toxicities associated with pembrolizumab'. Together they form a unique fingerprint.

Cite this