Minimal change disease onset observed after bevacizumab administration

Hanna, Ramy M; Lopez, Eduardo; Wilson, James; Barathan, Shrinath; Cohen, Arthur H.

doi:10.1093/ckj/sfv139

Cited by 33 publications

(43 citation statements)

References 28 publications

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“…In some cases, these drugs have triggered various glomerular diseases as well. 1 Intravitreal use of these drugs has been increasingly noted to contribute to the risk of vascular events, 5 and there is a growing body of evidence that these agents may contribute to proteinuria, and in some studies hypertension. 6 The now established finding that these anti-VEGF agents are absorbed systemically in significant quantities when given intravitreally is equally concerning.…”

Section: Discussionmentioning

confidence: 99%

“…2,8 Nephrotic syndrome can be caused via podocyte cytoskeleton effects can be observed as via disruption of C-MIP (though this is classically seen more with inhibition of the closely related tyrosine kinase pathway). 1,2,8 That is not all, as VEGF blockade can also induce changes in pro-thrombotic pathways (Diacyl-glycerol (DAG)-Kinase epsilon), in addition it affects nitric oxide signaling. 2,8 These are very well documented for systemic anti-VEGF toxicity and increasingly being shown in patients receiving intravitreal VEGF injections which are now known to be systemically absorbed according to Avery et al 3,9 An additional study by Tschulakow et al 10 also shows that not all VEGF blocking agents present the same risk.…”

Section: Discussionmentioning

confidence: 99%

“…However, VEGF blockade or blockade of associated pathways to any degree can result in proteinuria. [1][2][3][4] We report a case of a 37-year-old female with early-onset type 2 diabetes and diabetic retinopathy and nephropathy who developed an increase in blood pressures and proteinuria on bevacizumab. These measurements subsequently improved with switch to the lower potency intravitreally administered anti-VEGF agent: ranibizumab.…”

Section: Introductionmentioning

confidence: 99%

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Intravitreal bevacizumab-induced exacerbation of proteinuria in diabetic nephropathy, and amelioration by switching to ranibizumab

Hanna

Abdelnour

Hasnain

et al. 2020

SAGE Open Medical Case Reports

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Certain diabetic and hypertensive patients started on intravitreal vascular endothelial growth factor inhibition for diabetic retinopathy may experience worsening of hypertension and proteinuria. The etiology of this is the newly recognized absorption of intravitreally injected vascular endothelial growth factor inhibitors, and the susceptibility of patients with pre-existing renal disease to exacerbations depends on the degree of systemic absorption. There are eighteen reported cases of worsening hypertension, woresening proteinuria, worsening renal function, thrombotic microangiopathy, and glomerular disease noted after initiation of intravitreal vascular endothelial growth factor blockade. This nineteenth case demonstrates worsening hypertension and proteinuria with the start of bevacizumab. Both blood pressure and proteinuria parameters showed overall improvement with switching to the less absorbed and lower potency agent ranibizumab. There was a slight rise in serum creatinine after bevacizumab therapy, which stabilized at a new baseline, and the serum creatinine remained stable on ranibizumab. There were no other nephrotoxic exposures that explained the mild rise in serum creatinine. Because of improvement in renal function and proteinuria, a renal biopsy was deferred for the time. This case re-demonstrates the risk of worsening proteinuria with vascular endothelial growth factor inhibitors when given intravitreally in some patients. The demonstration of improvement in blood pressure and proteinuria with the use of lower potency agents like ranibizumab is novel and an important concept confirming observations from pharmacokinetic studies. The switch to ranibizumab offers a therapeutic option when proteinuria worsens with intravitreal vascular endothelial growth factor blockade, and the patient requires ongoing intravitreal therapy for treatment of diabetic retinopathy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intravitreal bevacizumab-induced exacerbation of proteinuria in diabetic nephropathy, and amelioration by switching to ranibizumab

Hanna

Abdelnour

Hasnain

et al. 2020

SAGE Open Medical Case Reports

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“…A kidney biopsy may be necessary in cases of progressive renal disease, unexplained renal failure or nephritic syndrome to exclude other etiologies (13). Onset or relapse of minimal change disease in the setting of bevacizumab therapy has also been described (20,21).…”

Section: Proteinuriamentioning

confidence: 99%

Biological agents in gastrointestinal cancers: adverse effects and their management

Arora¹,

Gupta²,

Singh³

2017

J. Gastrointest. Oncol.

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Biological therapy comprises agents that by virtue of their unique mechanisms of action, are able to specifically incite a response against or target malignant cells. They differ from conventional chemotherapy with regard to mechanisms of action, indications and side effect profile. Biologic agents have revolutionized therapy for a number of malignancies. In the setting of gastrointestinal (GI) malignancies, agents targeting vascular endothelial growth factor (VEGF), human epidermal growth factor receptor 2 (Her2/Neu) and epidermal growth factor receptor (EGFR) have proven to be invaluable additions to chemotherapy. However, these agents bring with them a set of side effects attributable to their unique mechanisms of action. The anti VEGF agents-bevacizumab, aflibercept and ramucirumab, can result in renal and vascular complications such as hypertension, arterial thrombotic events (ATE), proteinuria and GI perforations. The anti EGFR agents classically cause dermatological toxicities, in addition to hypomagnesemia, which can be dose limiting for patients. Trastuzumab, a monoclonal antibody that targets Her2/Neu, is known to cause cardiotoxicity, especially when used with anthracyclines. Use of immunotherapy agents such as nivolumab is associated with the development immune related adverse events (irAEs). The use of these agents is expected to increase over the next few years and it is crucial that patients and practitioners are aware of their adverse effects and current management strategies. This review highlights the adverse events associated with the use of biologic and immunologic therapies in GI cancers, their incidence and current management strategies.

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“…О развитии болезни минимальных изменений у 4 пациентов после введения бевацизумаба сообщает R. Hanna и соавт. [53]. Учитывая возможные несоответствия клинической картины -минимальных клинических проявлений и тяжелой почечной патологии, выявленной при биопсии, можно предположить, что проведение биопсии почки целесообразно даже у больных со стертыми клиническими проявлениями.…”

Section: äàííûå ìîðôîëîãè÷åñêèõ èññëåäîâàíèéunclassified

Nephrotoxicity of anti-angiogenesis drugs

Grechukhina

Chebotareva

Krasnova

2020

Terapevticheskii arkhiv

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Neoangiogenesis is a basic factor for most physiological as well as pathological processes i.e. tumor metastases. The most important is vascular endothelium growth factor (VEGF) and its receptors (VEGFR1/2) in angiogenesis processes. Nowadays antiangiogenic agents (which inhibit VEGF like bevacizumab neither VEGFR2 like ramucirumab) are widely used in very different chemotherapeutic regimens in clinical oncology. The signalling pathway VEGF-VEGFR plays a crucial role in supporting of adequate kidney function. Appearance of antiangiogenic drugs led to adverse nephrotoxic effects: arterial hypertension, proteinuria, rarely nephrotic syndrome, and kidney dysfunction. Various hystological variants of nephropathy are described, however, in most cases, signs of thrombotic microangiopathy of the renal vessels are noted. This literature review discusses mechanisms, clinical and morphological aspects of nephropathy associated with antiangiogenic drugs.

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Minimal change disease onset observed after bevacizumab administration

Cited by 33 publications

References 28 publications

Intravitreal bevacizumab-induced exacerbation of proteinuria in diabetic nephropathy, and amelioration by switching to ranibizumab

Intravitreal bevacizumab-induced exacerbation of proteinuria in diabetic nephropathy, and amelioration by switching to ranibizumab

Biological agents in gastrointestinal cancers: adverse effects and their management

Nephrotoxicity of anti-angiogenesis drugs

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