Membranoproliferative glomerulonephritis after intravitreal vascular growth factor inhibitor injections: A case report and review of the literature

Systemic administration of agents that inhibit vascular endothelial growth factor (VEGF) and therefore vascular proliferation is often used to treat various cancers. However, these agents are associated with a number of side effects, including proteinuria and renal injury. Intravitreal injection of...

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Bibliographic Details
Published in:	British journal of clinical pharmacology Vol. 89; no. 1; pp. 401 - 409
Main Authors:	Gan, Grace, Michel, Mathis, Max, Antoine, Sujet‐Perone, Nicolas, Zevering, Yinka, Vermion, Jean‐Charles, Zaidi, Mohamed, Savenkoff, Benjamin, Perone, Jean‐Marc
Format:	Journal Article
Language:	English
Published:	England 01-01-2023
Subjects:	Angiogenesis Inhibitors - adverse effects Bevacizumab Glomerulonephritis, Membranoproliferative - chemically induced Glomerulonephritis, Membranoproliferative - drug therapy Growth Inhibitors Humans Intravitreal Injections macular oedema membranoproliferative glomerulonephritis Middle Aged Ranibizumab - therapeutic use Receptors, Vascular Endothelial Growth Factor Recombinant Fusion Proteins systemic side effects Vascular Endothelial Growth Factor A VEGF macular oedema membranoproliferative glomerulonephritis intravitreal injections VEGF systemic side effects
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Summary:	Systemic administration of agents that inhibit vascular endothelial growth factor (VEGF) and therefore vascular proliferation is often used to treat various cancers. However, these agents are associated with a number of side effects, including proteinuria and renal injury. Intravitreal injection of anti‐VEGF agents has become the cornerstone of macular disease treatment. Since these agents cross the blood‐retina barrier and enter the circulation, systemic side effects have been reported. We report the novel case of a 57‐year‐old patient who presented with macular oedema secondary to central retinal vein occlusion, underwent three monthly loading‐dose injections with the anti‐VEGF agent ranibizumab, and 2 weeks after the second injection presented with biopsy‐verified membranoproliferative glomerulonephritis. Twelve weeks after presenting with renal failure and 10 weeks after his last anti‐VEGF injection, the patient demonstrated spontaneous recovery of his kidney function. The patient had a history that promoted renal fragility, including hypertension, liver transplantation 6 years earlier for alcohol‐related cirrhosis and new‐onset diabetes mellitus after transplant. Our literature review and case suggest that although adverse renal events after intravitreal anti‐VEGF injections are very rare, ophthalmologists and nephrologists should be aware of this risk.
Bibliography:	The Pirncipal Investigator is Jean‐Marc Perone. ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Review-3 content type line 23 ObjectType-Report-1
ISSN:	0306-5251 1365-2125
DOI:	10.1111/bcp.15558