Could my dad's kidney issues be a result of immunotherapy?

Question

Hi doctor,

My father, who is 70 years old, was diagnosed with metastatic urothelial carcinoma. A recent CT scan revealed lung metastasis, and he has been receiving Pembrolizumab for the past six weeks.

However, his creatinine level has increased to 2.3 mg/dL, and he is experiencing severe fatigue and a loss of appetite.

Could these kidney issues be a side effect of immunotherapy, or are they a result of disease progression?
Should we continue with the same drug or switch to chemotherapy for potentially better outcomes?
How often should we repeat PET scans to monitor his treatment response?

Please guide.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and understand your concern.

Thank you for sharing the detailed information about your father’s condition. It is clear that you are facing significant changes in his health, which understandably causes concern. Your decision to ask questions is responsible and will help ensure that his treatment proceeds safely and effectively.

From your description, your father has been on immunotherapy (Pembrolizumab) for six weeks, and now he is experiencing elevated creatinine levels, severe fatigue, and loss of appetite. These symptoms could have several causes, including:

Kidney-related side effects of immunotherapy can sometimes lead to inflammation or impaired renal function.
Disease progression, which may cause effects from metastases or medications he is currently taking.
Other contributing issues, such as dehydration, infection, or dysfunction of other internal organs.

To evaluate this situation more precisely, it is recommended to:

Perform full kidney function tests and urinalysis (including creatinine, electrolytes, and urine assessment).
Assess his hydration and nutritional status.
If possible, provide the latest CT (computed tomography) or PET (positron emission tomography) scan reports to evaluate the treatment response and metastatic disease status.

A definitive diagnosis will require an in-person clinical evaluation and further investigation. At this stage, it is not advisable to stop or change his treatment without careful assessment. However, the treating oncologist may consider adjusting the therapy or adding supportive care depending on the severity of the kidney effects.

For monitoring treatment response, PET or CT scans are typically repeated every 8 to 12 weeks, depending on the clinical status and the oncologist’s recommendations, but the schedule should be individualized.

General recommendations include:

Monitor hydration and nutrition closely.
Manage fatigue and appetite loss with supportive care, and report any sudden changes.
Avoid starting or changing any medication without medical supervision.
Seek urgent care if there is worsening fatigue, fever, or decreased urine output.

Please share any new test reports, imaging, or changes in condition so that advice can be updated and personalized. With careful follow-up, many patients can be effectively managed while maintaining a good quality of life.

I hope I have addressed all your questions. If there is anything else, please let me know.

Thank you.