{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T21:09:52Z","timestamp":1784408992253,"version":"3.55.0"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>\n                    Immune checkpoint inhibitors (ICIs) can cause immune-related adverse events (irAEs) affecting multiple organs. Distal renal tubular acidosis (dRTA) as a renal irAE is exceedingly rare, often delaying diagnosis due to nonspecific symptoms. A 63-year-old man with stage IIIA lung squamous cell carcinoma developed recurrent nausea and vomiting after three cycles of nab-paclitaxel\/carboplatin combined with tislelizumab. Laboratory evaluation revealed profound metabolic acidosis (CO\n                    <jats:sub>2<\/jats:sub>\n                    -CP nadir 11.6 mmol\/L) and life-threatening hypokalemia (serum potassium nadir 1.1 mmol\/L), requiring ICU admission and mechanical ventilation. Despite aggressive intravenous potassium supplementation (up to 20 mEq\/h), hypokalemia paradoxically worsened. Urine pH was 7.0 during systemic acidosis, indicating impaired renal acidification. After excluding other causes, a diagnosis of tislelizumab-induced dRTA was established. Tislelizumab was discontinued, and treatment with oral potassium citrate and prednisone (60 mg\/day, tapered over 5.5 months) led to complete resolution of metabolic abnormalities. Over one year of follow-up, the patient has maintained normal renal function without recurrence and achieved a major partial response of his lung cancer. This first reported case of tislelizumab-induced dRTA highlights the need for vigilance when encountering unexplained, potassium-refractory electrolyte disturbances during ICI therapy, emphasizing early diagnosis, drug discontinuation, and pathophysiology-guided therapy.\n                  <\/jats:p>","DOI":"10.3389\/fimmu.2026.1848498","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T05:47:08Z","timestamp":1781156828000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Tislelizumab-induced distal renal tubular acidosis presenting with life-threatening hypokalemia: a case report"],"prefix":"10.3389","volume":"17","author":[{"given":"Jiaju","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Tai\u2019an City Central Hospital","place":["Tai\u2019an, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lidong","family":"Qin","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Tai\u2019an City Central Hospital","place":["Tai\u2019an, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Tai\u2019an City Central Hospital","place":["Tai\u2019an, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Tai\u2019an City Central Hospital","place":["Tai\u2019an, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lili","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Tai\u2019an City Central Hospital","place":["Tai\u2019an, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongwei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Tai\u2019an City Central Hospital","place":["Tai\u2019an, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanqiu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Tai\u2019an City Central Hospital","place":["Tai\u2019an, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiao","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Tai\u2019an City Central Hospital","place":["Tai\u2019an, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meishu","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Tai\u2019an City Central Hospital","place":["Tai\u2019an, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaili","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Tai\u2019an City Central Hospital","place":["Tai\u2019an, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfab171","article-title":"Distal renal tubular acidosis: ERKNet\/ESPN clinical practice points","volume":"36","author":"Trepiccione","year":"2021","journal-title":"Nephrology Dialysis Transplant Off Publ Eur Dialysis Transplant Assoc - 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