A 75-year-old female with stage IV adenocarcinoma of the lung with low PD-L1 expression (1%) and an EGFR Exon 20 insertion and pre-existing stage III chronic renal disease secondary to diabetes mellitus was started on third-line systemic therapy with nivolumab/ipilimumab and developed stage 2 AKIN after 1 cycle of treatment. This evidence concerns the gene CD274 and chronic kidney disease.