Proteinuria in a patient receiving anti-VEGF therapy for metastatic renal cell carcinoma

Nat Clin Pract Nephrol. 2007 May;3(5):287-93. doi: 10.1038/ncpneph0476.


Background: A 59-year-old man who had undergone a left nephrectomy for renal cell carcinoma was found to have metastatic disease during a restaging examination. The patient was started on treatment with interferon alpha2b plus bevacizumab, a humanized monoclonal anti-vascular endothelial growth factor antibody. After 9 months of this therapy, the patient developed proteinuria, which gradually increased to over 6 g/day.

Investigations: Physical examination, urine and blood analysis, biopsy of the right kidney, and histologic evaluation of the non-neoplastic portion of the left nephrectomy specimen.

Diagnosis: Thrombotic microangiopathy and IgA immune-complex deposition in the glomerular capillary walls and mesangium.

Management: Discontinuation of interferon alpha2b and bevacizumab, control of blood pressure with an angiotensin-converting-enzyme inhibitor and an angiotensin-receptor blocker.

Publication types

  • Case Reports

MeSH terms

  • Angiogenesis Inhibitors / administration & dosage
  • Angiogenesis Inhibitors / adverse effects*
  • Antibodies, Monoclonal / administration & dosage
  • Antibodies, Monoclonal / adverse effects*
  • Antibodies, Monoclonal, Humanized
  • Bevacizumab
  • Carcinoma, Renal Cell / drug therapy
  • Carcinoma, Renal Cell / pathology*
  • Humans
  • Interferon alpha-2
  • Interferon-alpha / administration & dosage
  • Interferon-alpha / adverse effects
  • Kidney Neoplasms / pathology*
  • Lung Neoplasms / drug therapy*
  • Lung Neoplasms / secondary
  • Male
  • Middle Aged
  • Proteinuria / chemically induced*
  • Recombinant Proteins
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors


  • Angiogenesis Inhibitors
  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Interferon alpha-2
  • Interferon-alpha
  • Recombinant Proteins
  • Vascular Endothelial Growth Factor A
  • Bevacizumab