A surreal digital illustration symbolizing kidney protection during immunotherapy.

Kidney Alert: How Common Medications Can Turn Toxic During Immunotherapy

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Reese Marlowe in Health & Wellness May 2025 • 4 min read.

"Uncover the hidden risks of combining immunotherapy with everyday drugs and learn how to protect your kidney health."


Immunotherapy, a revolutionary approach in cancer treatment, harnesses the power of the body's immune system to fight cancer cells. While these treatments, particularly immune checkpoint inhibitors (ICPIs) like anti-PD-1 and anti-CTLA-4 antibodies, have shown remarkable success, they also come with a unique set of challenges. One increasingly recognized complication is acute tubulointerstitial nephritis (ATIN), a type of kidney injury.

ATIN occurs when the spaces between the kidney tubules become inflamed, disrupting normal kidney function. ICPIs can sometimes trigger this inflammation, leading to kidney damage. What makes this situation particularly complex is that the interaction between immunotherapy and other medications a patient is taking can significantly increase the risk of ATIN. This means drugs that have been safely used for years can suddenly become problematic when combined with these cancer treatments.

This article explores the intricate link between ICPIs, seemingly harmless medications, and kidney health, emphasizing the critical need for awareness and careful management of drug combinations during immunotherapy. We will delve into a compelling case study that highlights this risk, offering valuable insights for patients and healthcare professionals alike.

The Silent Threat: When Safe Medications Become Dangerous

A surreal digital illustration symbolizing kidney protection during immunotherapy.

One of the major concerns with ICPIs is their potential to disrupt the body's established immune tolerance to various substances, including medications. Immune tolerance is the process by which the immune system learns to recognize and ignore certain substances, preventing it from launching an attack against them. ICPIs can interfere with this process, causing the immune system to react to drugs that were previously well-tolerated.

Consider the following case: A 67-year-old man undergoing treatment for stage IV non-small-cell lung cancer developed kidney injury during nivolumab therapy, an anti-PD-1 antibody. A kidney biopsy confirmed ATIN. What was particularly striking was that for over four years before starting nivolumab, the patient had been taking lansoprazole, a proton pump inhibitor (PPI), to manage acid reflux. Lansoprazole is a known cause of drug-induced ATIN, but the patient had experienced no kidney problems during those four years.
  • The Culprit: Lansoprazole, a common PPI, which had been safely used for years.
  • The Trigger: Nivolumab, an anti-PD-1 antibody, disrupting immune tolerance.
  • The Result: Acute tubulointerstitial nephritis (ATIN), leading to kidney injury.
After nivolumab treatment began, the patient's immune system appeared to lose its tolerance to lansoprazole, triggering an inflammatory response in the kidneys. The situation improved rapidly once lansoprazole was stopped, highlighting the importance of recognizing and discontinuing potentially harmful medications during immunotherapy. A drug-induced lymphocyte stimulation test (DLST) confirmed that lansoprazole was the culprit.

Protecting Your Kidneys: A Call to Vigilance

This case underscores the importance of vigilance and careful drug management during immunotherapy. While corticosteroids are often recommended to manage ICPI-associated kidney injury, recognizing and discontinuing concomitant drugs, especially those known to cause ATIN, is essential. Patients and healthcare providers must work together to ensure all medications are carefully reviewed and monitored throughout the treatment process.

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