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Background <p>Among immune-related adverse events (irAEs) associated with immune checkpoint inhibitors (ICIs), skin and gastrointestinal toxicities are more frequently observed, whereas severe renal impairment remains uncommon.</p> Case presentation <p>We herein report a case of immune checkpoint inhibitor-associated acute kidney injury (ICPi-AKI) in a 59-year-old Chinese male with lung squamous cell carcinoma and a history of splenectomy, occurring within two weeks after the first administration of tislelizumab. The patient was managed with intravenous methylprednisolone, intermittent hemodialysis, and subsequent continuous renal replacement therapy (CRRT), resulting in gradual normalization of serum creatinine levels. Notably, this patient had previously undergone splenectomy. It is postulated that splenectomy may increase the risk of irAEs following ICI therapy, potentially through excessive activation of effector T (Teff) cells.</p> Conclusion <p>Heightened vigilance is warranted regarding the potential for severe immunotherapy-related toxicity in lung cancer patients with a prior history of splenectomy. For such cases, empirical high-dose glucocorticoids and supportive care—including renal replacement therapy when indicated—is strongly advised.</p>

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Prior splenectomy as a potential risk factor for severe immune checkpoint inhibitor–associated kidney injury: a case report

  • 期刊论文

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  • 发表日期：

    2026年7月30日

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  • Yiheng Yu,
  • Daxiong Zeng

摘要

Background

Among immune-related adverse events (irAEs) associated with immune checkpoint inhibitors (ICIs), skin and gastrointestinal toxicities are more frequently observed, whereas severe renal impairment remains uncommon.

Case presentation

We herein report a case of immune checkpoint inhibitor-associated acute kidney injury (ICPi-AKI) in a 59-year-old Chinese male with lung squamous cell carcinoma and a history of splenectomy, occurring within two weeks after the first administration of tislelizumab. The patient was managed with intravenous methylprednisolone, intermittent hemodialysis, and subsequent continuous renal replacement therapy (CRRT), resulting in gradual normalization of serum creatinine levels. Notably, this patient had previously undergone splenectomy. It is postulated that splenectomy may increase the risk of irAEs following ICI therapy, potentially through excessive activation of effector T (Teff) cells.

Conclusion

Heightened vigilance is warranted regarding the potential for severe immunotherapy-related toxicity in lung cancer patients with a prior history of splenectomy. For such cases, empirical high-dose glucocorticoids and supportive care—including renal replacement therapy when indicated—is strongly advised.