Case report demonstrates severe anti-GBM glomerulonephritis and acute kidney failure in a patient receiving tremelimumab for metastatic melanoma, highlighting rare renal autoimmune toxicity.
Cytotoxic T-lymphocyte-associated antigen-4 (CTLA4) antagonists are currently being investigated in patients with metastatic malignant melanoma. It is proposed that this therapy will upregulate T-cell responses to melanoma cells while simultaneously targeting regulatory T lymphocytes (Tregs) which are known to suppress the host’s immune response to cancer cells. In some of these patients, immune-mediated adverse events such as enterocolitis, dermatitis, uveitis and hepatitis have been observed. We report a case of a 50-year-old man presenting with cough, fever, macroscopic haematuria and oligoanuric kidney failure following treatment with the CTLA4 antagonist tremelimumab for metastatic malignant melanoma. Kidney biopsy demonstrated crescentic glomerulonephritis and strong linear glomerular basement membrane (GBM) staining for IgG and C3; serum anti-GBM antibody level was markedly elevated (>200 U/ml).
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Sammartino et al. (2009) studied this question.
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