Renal toxicities have been increasingly recognized as complications of immune checkpoint inhibitor therapy. These drugs are associated with a broad range of immune-related adverse events in the kidney, including interstitial nephritis, glomerulonephritis, and acute tubular necrosis. We describe a woman with a rare pattern of injury, osmotic tubulopathy, after exposure to pembrolizumab that has been described only once before in the medical literature. As a result of these observations, vacuolar tubular injury pattern that has the appearance of an osmotic lesion should be considered as a possible consequence of immune checkpoint inhibitor therapy.
