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

Nature Clinical Practice Nephrology volume 3, pages 287–293 (2007)Cite this article

Abstract

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 α2b 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 α2b and bevacizumab, control of blood pressure with an angiotensin-converting-enzyme inhibitor and an angiotensin-receptor blocker.

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Figure 1: Light microscopy of the kidney biopsy
Figure 2: Light microscopy of the kidney biopsy
Figure 3: Immunofluorescence microscopy of the kidney biopsy
Figure 4: Electron microscopy of the kidney biopsy
Figure 5: Sections of non-neoplastic areas of the cortex from the original specimen obtained from partial nephrectomy for renal cell carcinoma
Figure 6: Electron micrograph of a glomerular capillary loop from a partial nephrectomy specimen from the patient described in Box 1

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Authors and Affiliations

  1. D Roncone is a Senior Fellow in the Nephrology Division Fellowship Program, A Satoskar is a Clinical Instructor in the Renal Pathology Division, T Nadasdy is Director of the Renal Pathology Division and Professor of Pathology, JP Monk is an Assistant Professor of Medicine in the Division of Hematology and Medical Oncology, and BH Rovin is Director of the Division of Nephrology and Professor of Medicine and Pathology, all at The Ohio State University College of Medicine, Columbus, OH, USA.,

    Daniel Roncone, Anjali Satoskar, Tibor Nadasdy, J Paul Monk & Brad H Rovin

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  1. Daniel Roncone
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  2. Anjali Satoskar
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  3. Tibor Nadasdy
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  5. Brad H Rovin
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Corresponding author

Correspondence to Brad H Rovin.

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The authors declare no competing financial interests.

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Roncone, D., Satoskar, A., Nadasdy, T. et al. Proteinuria in a patient receiving anti-VEGF therapy for metastatic renal cell carcinoma. Nat Rev Nephrol 3, 287–293 (2007). https://doi.org/10.1038/ncpneph0476

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  • DOI: https://doi.org/10.1038/ncpneph0476

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