Pembrolizumab-Induced Acute Interstitial Nephritis: Case Report of a Colorectal Cancer Patient

Abstract

Supriya Peshin, Nirmay Sonar, Zaynah Sadiq and Gurvinder Kaur

The emergence of immune checkpoint inhibitors (ICIs) has revolutionized cancer treatment, offering new hope to patients with advanced malignancies. Pembrolizumab (Keytruda), a PD-1-targeting ICI, is integral in treating various cancers, such as melanoma, non-small cell lung cancer, renal cell carcinoma, and Hodgkin lymphoma, by enhancing T-cell activity against cancer cells. Despite its efficacy, pembrolizumab is associated with immune-related adverse events (irAEs), including renal complications like acute tubulointerstitial nephritis (ATIN). This case report presents a 58-year-old female with stage IIa colorectal cancer on pembrolizumab therapy, who developed acute kidney injury (AKI) manifesting as worsening fatigue, decreased urine output, and malaise. Laboratory findings indicated elevated serum creatinine and the presence of white blood cell casts in the urine. Renal biopsy confirmed lymphocytic and eosinophilic infiltration of the interstitial tissues, consistent with pembrolizumab-induced nephritis. Following treatment with prednisone and supportive measures, her renal function improved, allowing continued pembrolizumab therapy. This case highlights the necessity of vigilant monitoring and early intervention for renal irAEs in patients on ICIs to optimize outcomes and minimize long-term renal damage.

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