Anti-VEGF-related thrombotic microangiopathy in a child presenting with nephrotic syndrome

Pediatr Nephrol. 2016 Jun;31(6):1029-32. doi: 10.1007/s00467-016-3355-z. Epub 2016 Feb 29.

Abstract

Background: Targeting the vascular endothelial growth factor (VEGF) signaling pathway has become an important approach to current cancer therapy. Anti-VEGF therapy-related renal adverse effects may present as hypertension, non-nephrotic proteinuria, and rarely as nephrotic syndrome (NS) and acute kidney injury.

Case-diagnosis/treatment: In this report, we present a 15-year-old boy who had developed nephrotic syndrome and thrombotic microangiopathy 26 months after administration of anti-VEGF therapy. Treatment was discontinued and nephrotic syndrome remitted spontaneously within 3 months.

Conclusions: Nephrologists should be aware of the side effects of anti-VEGF therapy. Early diagnosis and prompt management with withdrawal of the agents will result in spontaneous remission.

Keywords: Anti-VEGF; Bevacizumab; Child; Nephrotic syndrome; Thrombotic microangiopathy.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Angiogenesis Inhibitors / adverse effects*
  • Angiogenesis Inhibitors / therapeutic use
  • Antineoplastic Agents / adverse effects*
  • Antineoplastic Agents / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects*
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Bevacizumab / adverse effects
  • Bevacizumab / therapeutic use
  • Bone Neoplasms / drug therapy
  • Cisplatin / therapeutic use
  • Doxorubicin / therapeutic use
  • Humans
  • Ifosfamide / therapeutic use
  • Male
  • Methotrexate / therapeutic use
  • Nephrotic Syndrome / chemically induced*
  • Nephrotic Syndrome / diagnosis
  • Niacinamide / adverse effects
  • Niacinamide / analogs & derivatives
  • Niacinamide / therapeutic use
  • Osteosarcoma / drug therapy
  • Phenylurea Compounds / adverse effects
  • Phenylurea Compounds / therapeutic use
  • Proteinuria / diagnosis
  • Proteinuria / etiology
  • Remission, Spontaneous
  • Sorafenib
  • Thrombotic Microangiopathies / chemically induced*
  • Thrombotic Microangiopathies / diagnosis
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors*
  • Withholding Treatment

Substances

  • Angiogenesis Inhibitors
  • Antineoplastic Agents
  • Phenylurea Compounds
  • Vascular Endothelial Growth Factor A
  • Niacinamide
  • Bevacizumab
  • Doxorubicin
  • Sorafenib
  • Cisplatin
  • Ifosfamide
  • Methotrexate