Multiorgan Toxicity from Dual Checkpoint Inhibitor Therapy, Resulting in a Complete Response-A Case Report.

Immunotherapy treatment with checkpoint inhibitors (ICIs) has led to a breakthrough in the treatment of oncological diseases. Despite its clinical effectiveness, this treatment differs from others, such as cytotoxic chemotherapy, in that it causes immune-related adverse events. This type of toxicity can affect any organ or organ system of the body. We present a literature review and a rare clinical case from our clinical practice, in which a patient with metastatic clear cell renal carcinoma was treated with a single dose of dual checkpoint blockade (cytotoxic T-lymphocyte-4 (CTLA-4) and programmed death-1 (PD-1)) and simultaneously diagnosed with colitis, hepatitis, and nephritis. After early immunosuppressive treatment with the glucocorticoids, complete organ function recovery was achieved. The follow-up revealed a sustained complete response lasting more than a year.

[Acute renal failure in patients with alcoholic surrogate intoxication]. / Uminis inkstu nepakankamumas apsinuodijus alkoholio surogatais.

Intoxications with alcoholic surrogates are still frequent in Lithuania. The aim of this study was to evaluate the frequency, course, and effectiveness of treatment and outcomes of acute renal failure in patients with alcoholic surrogate intoxication. We have analyzed the case histories of 94 patients with alcoholic surrogate poisoning. Patients were treated in the Clinic of Nephrology, Kaunas University of Medicine Hospital, during 1997-2006. Fifty-three cases of poisoning with unspecified ethanolic surrogates, which did not provoke acute renal failure, were identified, and we did not analyze them in detail. Forty-one cases of intoxication with nonethanolic surrogates were identified, and acute renal failure developed in 34 patients. In 31 of the 41 patients, hemodialysis was started for toxin removal. Among eight patients in whom treatment was started within 12 hours of intoxication, seven (87.5%) patients had no acute renal failure. In the 23 remaining patients, treatment was started later than 12 hours after intoxication, and acute renal failure was diagnosed in all of them. Three patients died within 48 hours after hospitalization because of severe intoxication. CONCLUSION. Acute renal failure developed in 82.9% of patients poisoned with nonethanolic surrogates. In such cases, when hemodialysis for toxin removal was started up to 12 h after poisoning, acute renal failure developed significantly rarely.