Biopsy-Confirmed Severe Acute Kidney Injury Requiring Emergent Hemodialysis After Eight Months of Alectinib Therapy.

Anaplastic lymphoma kinase (ALK) inhibitors such as alectinib are standard first-line treatments for ALK-positive lung cancers. While alectinib is generally well tolerated and provides excellent disease control, rare reports have suggested renal toxicities associated with alectinib treatment. Here, we report a case of a 60-year-old man with a history of stage IV non-small cell lung cancer who had been receiving alectinib for eight months and presented to the emergency department with anuria, acutely elevated creatinine, and hyperkalemia. Nephrotoxic medications, including alectinib, were suspended in the setting of severe acute kidney injury (AKI). He was started on emergent hemodialysis and treated with corticosteroids, leading to resolution of the kidney injury and electrolyte abnormalities. Renal biopsy revealed mixed acute tubular necrosis and acute interstitial nephritis. This case reinforces the rare association between alectinib and AKI, emphasizing the importance of monitoring for and recognizing signs of nephrotoxicity in patients receiving this therapy, even after months of stable renal function.