Dr Cian O’Leary1, Dr David Wong2, Dr Gregory John Wilson1,3
1Mater Kidney Health Service, South Brisbane, Australia, 2Department of Anatomical Pathology, Mater Adult Hospital, South Brisbane, Australia, 3University of Queensland Faculty of Medicine, Brisbane, Australia
Background
Acute interstitial nephritis (AIN) is a frequent cause of acute kidney injury (AKI) and is commonly drug induced. Vedolizumab, a monoclonal antibody used in the treatment of refractory ulcerative colitis (UC), has been reported to cause AIN. We describe the first case of vedolizumab induced AIN in which pre-dose steroid prophylaxis failed to prevent a recurrence of AIN on rechallenging with vedolizumab.
Case Report
A 21-year-old male with a history of refractory UC presented with a history of malaise, fevers, and nausea. He had commenced vedolizumab 6 months prior and recently received his 3rd dose. Initial investigations showed pyuria (>500 leucocytes x106), AKI (serum creatinine 133 µmol/L, ref range: 60-100 µmol/L) and bilateral renal echogenicity. Following initial improvement with antibiotics and fluids (serum creatinine 100 µmol/L) he was discharged. Following a further dose of vedolizumab his renal functioned worsened (serum creatinine 185 µmol/L) and he underwent kidney biopsy. This demonstrated AIN with a 50% lymphocyte rich interstitial infiltrate. Vedolizumab was withheld and renal function spontaneously improved (serum creatinine 138 µmol/L). In view of his refractory UC and limited treatment options, vedolizumab was re-trialed with high dose prednisone prophylaxis. This was unsuccessful, with further deterioration in his renal function (serum creatinine 186 µmol/L) requiring a prolonged course of high dose prednisone to treat which was weaned over 4 months. 12 months after cessation of vedolizumab his renal function remained impaired (serum creatinine 108 µmol/L).
Conclusions
We present the first case of vedolizumab induced AIN with failed steroid prophylaxis. This case highlights the importance of balancing the risk and benefits of continuing an effective treatment for a refractory disease when AIN is a complication of treatment.
Biography:
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