Kidney injury during VEGF inhibitor therapy

• Published in: Netherlands journal of medicine Vol. 70; no. 6; pp. 267 - 271
• Main Authors: DEN DEURWAARDER, E. S. G, DESAR, I. M. E, STEENBERGEN, E. J, MULDERS, P. F, WETZELS, J. F. M, HERPEN, C. M. L. Van
• Format: Journal Article
• Language: English
• Published: Alphen aan den Rijn Van zuiden 01-08-2012
• Subjects: Biological and medical sciences; General aspects; Glomerulosclerosis, Focal Segmental; Humans; Kidney; Medical sciences; Nephrotic Syndrome; Proteinuria; Vascular Endothelial Growth Factor A; Kidney toxicity; Trauma; Kidney; Medicine; Vascular endothelium growth factor; Treatment; anti-VEGF therapy; Urinary system; FSGS; Inhibitor; Anti-VEGF; Lesion; Antiangiogenic agent; Nephrotoxicity; Cediranib
• ISSN: 0300-2977; 1872-9061

Antiangiogenic therapy targeting vascular endothelial growth factor (VEGF) or its receptor (VEGFR) has proven its effect in the treatment of several types of cancer, including renal cell carcinoma (RCC). However, treatment can be accompanied by notable adverse effects. Mild proteinuria and hypertension are often seen, but sometimes nephrotic range proteinuria and÷or renal insufficiency develop. In recent years insight into the toxic effects of anti-VEGF therapy in the kidney has increased. A few biopsies have been done and thrombotic microangiopathy is reported in the majority of cases. However, other patterns of kidney injury have been described as illustrated by the case of a 62-year-old patient who presented two years after initiation of the VEGFR inhibitor cediranib with a nephrotic syndrome and acute renal failure. Kidney biopsy disclosed focal segmental glomerulosclerosis (FS GS) and interstitial nephritis. Partial remission was achieved after stopping the cediranib and a short course of prednisone. We review the different forms of kidney injury that could be caused by anti-VEGF therapy.