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Renal granulomatous arteritis: case report A 67-year-old woman developed renal granulomatous arteritis during treatment with nivolumab and ipilimumab for metastatic melanoma. The woman started receiving immune checkpoint inhibitor (ICI) therapy with nivolumab and ipilimumab [routes and dosages not stated] for metastatic melanoma. However, following 2 months of therapy, she developed bacteriuria, fever, chills and diarrhoea. The bacteriuria improved with unspecified antibiotics; however, the fever persisted. Her serum creatinine increased from 0.63 to 4.24 mg/dL over 9 days. Urinalysis revealed proteinuria (1.47 g/gCr) and persistent pyuria. A renal biopsy showed granulomatous inflammation along the two interlobular arteries. Additionally, predominant infiltration of macrophages and CD4+ T-cells was noted in the interstitium, mainly around the interlobular arteries. Morphologic changes in tubular epithelial cells indicative of acute injury were noted, including vacuolisation, foamy degeneration, and flattening and detachment from the basement membrane. Based on these findings, she was diagnosed with renal granulomatous arteritis secondary to ICIs. The woman was then treated with prednisolone, with improvement in her symptoms. Her serum creatinine decreased to 1.0 mg/dL in 1 month. Ishimura N, et al. Renal granulomatous arteritis induced by immune checkpoint inhibitors. Kidney International 98: 793, No. 3, Sep 2020. Available from: URL: http:// 803504611 doi.org/10.1016/j.kint.2020.03.008

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Reactions 3 Oct 2020 No. 1824