Introduction: The efficacy and safety of nivolumab for patients receiving hemodialysis remain uncertain. Herein, we report a patient receiving a maintenance hemodialysis with life-threatening interstitial pneumonitis caused by nivolumab for metastatic renal cell carcinoma.
Case presentation: A 61-year-old man with chronic kidney disease after nephrectomy for renal cell carcinoma was started on hemodialysis. Six months later, he developed multiple bone metastases and received pazopanib. Pazopanib, however, was not effective. We then switched to nivolumab as second-line treatment. Five days after the first administration of nivolumab, he complained of respiratory discomfort and malaise with oxygen desaturation. Chest computed tomography demonstrated diffuse areas of ground glass opacity in both lung fields, suggesting programmed cell death 1 inhibitor-related pneumonitis. Prompt corticosteroid therapy led to improvement of the symptoms.
Conclusion: Caution should be exercised on the administration of nivolumab to hemodialysis patients due to the risk of interstitial pneumonitis.
Keywords: HD patients; PD‐1 inhibitor‐related pneumonitis; metastatic renal cell carcinoma; nivolumab.
© 2019 The Authors. IJU Case Reports published by John Wiley & Sons Australia, Ltd on behalf of the Japanese Urological Association.