肾癌术后复发免疫治疗并发多器官功能障碍综合征分析并文献复习OA

Objective To investigate the clinical characteristics,diagnosis,and treatment measures of immune-related adverse events(irAEs)in patients with postoperative recurrence of renal cell carcinoma,aiming to provide references for the early identification,diagnosis,treatment,and prevention of irAEs.Methods A retrospective analysis was conducted on the clinical data and treatment process of a patient with postoperative recurrence of renal cancer who developed irAEs after immunotherapy in 2025,and relevant literature was reviewed.Results A patient with renal cell carcinoma underwent laparoscopic robot-assisted operation combined with laparoscopic left nephrectomy.Three years afterwards,without any obvious cause,he experienced sudden lower back pain,accompanied by radiation pain in the right lower limb and limited mobility.After relevant examinations,bone metastasis in the left kidney after surgery and lymph node metastasis in the retroperitoneum were considered.After multidisciplinary discussion,it was recommended to use immunotherapy combined with targeted therapy and local radiotherapy for bone metastasis.Therefore,Sunitinib combined with Teprotumumab was given for treatment.At 10 d after the immunotherapy with Teprotumumab,symptoms such as nausea,vomiting,and fever occurred.Based on the comprehensive results of laboratory tests,several conditions were considered,including immune-induced liver injury grade 3,acute kidney injury stage 2,thrombocytopenia grade 4,and hyponatremia.The diagnosis of multiple organ dysfunction syndrome was made.After multidisciplinary consultation,corresponding treatment was administered,and the patient's condition improved.After stabilization,radiotherapy for bone metastases was initiated,which was administered over 3 weeks for a total of 12 fractions.The patient's lower back pain was completely relieved,liver and kidney functions as well as blood routine returned to normal.Targeted therapy was continued.Conclusion irAEs may involve various organ systems.Timely identification,diagnosis and effective treatment of adverse reactions in different systems and at different levels can achieve better results and improve the prognosis of patients.