Patient is a 50-year-old female originally sent to the office for consultation regarding a creatinine of 1.8 mg/dL, new-onset resistant hypertension, and subnephrotic-range proteinuria of 2.5 grams/day.
Medical history:
History of recurrent, metastatic melanoma 2013 (original excision 1985). She began therapy for her metastatic melanoma with with ipilimumab/nivolumab (“Checkpoint Inhibitors”) 2 years prior to current presentation. However, therapy was discontinued after approximately 8 months due to hepatitis (treated with steroids). In light of persistent disease, an alternative regimen was started with MAPK inhibitors dabrafenib and trametinib, which she has been now been using for approximately one year.
Physical Exam:
Overweight
2+ lower extremity edema but no rash or pulmonary findings.
Laboratory and other data:
Normal creatinine couple months after ipilimumab/nivolumab discontinuation.
She presented to nephrology with creatinine of 1.8 mg/dL six months after that, while on dabrafenib and trametinib.
UA with dysmorphic RBCs and 2.5 gram proteinuria by spot ratio. Negative SPEP/IFE, ANCA, anti-GBM, C3/C4, ANA. Hb 10 mg/dl, platelets normal, haptoglobin normal.
Chest X-ray normal.