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NDT Plus Advance Access published online on November 12, 2008
NDT Plus, doi:10.1093/ndtplus/sfn168
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Published by Oxford University Press on behalf of ERA-EDTA [2008].

Progressive bevacizumab-associated renal thrombotic microangiopathy*

Alice L. Uy1, Novae B. Simper2, Anne L. Champeaux2 and Robert M. Perkins1

1 Department of Medicine, Nephrology Service
2 Department of Pathology, Madigan Army Medical Center, Tacoma, WA 98431, USA

Correspondence: Correspondence and offprint requests to: Robert M. Perkins, Assistant Chief, Nephrology Service, Madigan Army Medical Center, Fitzsimmons Drive, Tacoma, WA 98431, USA. Tel: +1-253-968-1734; Fax: +1-253-968-1188; E-mail: rmperk1{at}yahoo.com


  Abstract

Vascular endothelial growth factor (VEGF) is integral to the integrity of the glomerular filtration barrier. Bevacizumab is a humanized monoclonal antibody directed against VEGF with expanding clinical applications for metastatic solid tumours. We describe a case of a 61-year-old female with ovarian cancer and baseline chronic kidney disease who received three doses of bevacizumab and subsequently developed progressive renal clearance dysfunction and nephrotic range proteinuria. A renal biopsy was performed 4 months after drug discontinuation and was consistent with TMA. At baseline, prior to bevacizumab exposure, her estimated glomerular filtration rate (eGFR) was 44 mL/min/1.73 m2 and she had no proteinuria. At the completion of therapy, eGFR was 27 mL/min/1.73 m2 with 1+ proteinuria on urinalysis. Her renal failure and proteinuria continued to progress 5 months after discontinuation of bevacizumab therapy, at which time eGFR was 11 mL/min/1.73 m2 and proteinuria was 5.5 g/24 h. Non-remitting TMA after bevacizumab therapy in patients with pre-existing chronic kidney disease has not been previously reported. Further studies are needed to assess the safety of this drug in patients with chronic kidney disease.

Key Words: bevacizumab • renal failure • thrombotic microangiopathy • VEGF inhibitor

Received for publication October 6, 2008. Accepted for publication October 14, 2008.

* The views expressed are those of the authors and do not constitute an endorsement by the Department of Defense. This is a US government work. There are no restrictions on its use.


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