-Case Reports-

Immune Checkpoint Inhibitor-Related Immunoglobulin A Nephropathy in a Patient with Advanced Head and Neck Cancer

Sae Aratani¹, Takeshi Matsunobu², Masashi Nakaishi², Akira Shimizu³, Tetsuya Kashiwagi¹, Yukinao Sakai¹, Kimihiro Okubo² and Masato Iwabu¹

¹Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
²Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
³Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan

Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of many cancers, including cancers of the head and neck. Despite the promising therapeutic efficacy of ICIs, immune-related adverse events (irAEs) are a major concern. Acute tubular injury and interstitial nephritis are the most common irAEs involving the kidneys. The present patient was diagnosed as having advanced papillary squamous cell carcinoma of the head and neck. After failure of the initial treatments, including chemotherapy, nivolumab (programmed death-1 inhibitor) was introduced. Shortly after initial administration of nivolumab, the patient developed acute kidney injury with hematuria and proteinuria. A renal biopsy and his clinical course indicated a diagnosis of ICI-related IgA nephropathy. Although glomerular involvement in irAEs is rare and challenging to treatment, the present patient was successfully treated with steroids, which improved kidney function and led to complete remission, as confirmed by urinalysis.

J Nippon Med Sch 2025; 92: 420-425

Keywords
acute kidney injury, IgA nephropathy, immune-related adverse effects, nivolumab, head and neck cancer

Correspondence to
Sae Aratani, MD, PhD, Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
sae-aratani@nms.ac.jp

Received, May 3, 2024
Accepted, August 5, 2024