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

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. 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. 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.