Durvalumab-associated nephrotic syndrome and organizing pneumonia: a case report.
Takashi Nawata, Masaki Shibuya, Maki Asami-Noyama et al.
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Case in brief
A 68-year-old man with unresectable advanced non-small cell lung cancer developed nephrotic syndrome and organizing pneumonia after starting durvalumab therapy. Despite glucocorticoid treatment for pneumonia, he experienced significant proteinuria. A renal biopsy confirmed durvalumab-associated nephrotic syndrome, showing features similar to focal segmental glomerulosclerosis. His proteinuria improved after discontinuing durvalumab and initiating treatment with losartan potassium, dapagliflozin, and finerenone.
What made this case unusual
The case illustrates a complex histological presentation of durvalumab-associated nephrotic syndrome, with features resembling focal segmental glomerulosclerosis and prominent tubulointerstitial nephritis.
Diagnostic / clinical pearl
Clinicians should be aware of the potential for immune checkpoint inhibitors like durvalumab to cause nephrotic syndrome, which may present with atypical histological features.
Why it matters
Understanding the diverse manifestations of immune-related adverse events can aid in timely diagnosis and management, improving patient outcomes in those receiving immunotherapy.