PMC7469242_01
Acute kidney injury (AKI) in the setting of immune reconstitution following treatment with alemtuzumab (ALM). Trajectories of serum creatinine, T-helper (CD4+ CD8+), and T-cell CD4+ counts in relation with drug administration are shown. Rituximab (RTX) was administered during the present admission, and resolution of AKI was seen afterward. High CD8+/CD4+ ratio was noticed throughout the patient's clinical course.
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Figure1
On further review, it was noticed that her thyroid and renal dysfunction followed the slow recovery of her T-helper counts, which occurred ~ 10 months after her initial round of alemtuzumab (Figure 1). Her kidney function improved significantly, with a new baseline Cr at 0.9 mg/dL (Figure 1).
A kidney biopsy showed global glomerulosclerosis in 2 of 14 glomeruli, segmental sclerosis in 1 of 14 glomeruli (A), extra-capillary proliferation (cellular crescents) in 1 of 14 glomeruli (B), glomerulomegaly, ~ 5% tubule atrophy, 10% interstitial fibrosis, and arteriolar hyalinosis. Immunofluorescence analysis showed no significant immunoglobulin or complement label; electron microscopic studies showed nonspecific ultrastructural alterations.
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Figure2
A kidney biopsy was performed due to the high suspicion of an underlying glomerulonephritis (GN) in the setting of immune reconstitution, which had findings consistent with pauci-immune GN with a focal and segmental lesion (Figure 2).