Ipilimumab and renal disease

Ipilimumab is a human monoclonal antibody that targets T lymphocytes antigen-4 or CTLA-4 and it’s used in clinical practice to treat melanoma.  Does this agent lead to nephrotoxicity?

Where do we encounter CTLA-4 in the renal literature?

Agonists to reduce immune activity using CTLA-4 Ig are available such as Orencia( abatacept) for SLE and RA.  Belatacept is a similar agent used in transplantation literature for treatment and prevention of rejection.  How are they different from ipilimumab that is used to treat cancer?  This antibody binds to human CD152 and enhances T cell response especially against tumor cells. It basically boosts the immune response against the tumor cells.  So invitation of the T cells into the kidney could be possible- and renal injury a potential side effect.

Literature search revealed three published cases.

One is a case of granulomatous AIN

Other is a vasculitis

And a NEJM case report on the drug causing lupus like nephritis.

It seems that the treatment of this leads to activation of T cells that can stimulate a classic vasculitis or interstitial nephritis. 

As the cancer literature grows,  we have to be mindful of the nephrotoxicites of such agents.