Department of Nephrology, Heraklion University Hospital, Crete, Greece.
Nephrol Dial Transplant. 2011 May;26(5):1742-5. doi: 10.1093/ndt/gfr093. Epub 2011 Mar 7.
Bevacizumab, a vascular endothelial growth factor (VEGF) inhibitor, has been widely used in a variety of malignancies offering substantial clinical benefit. Hypertension and proteinuria are the most commonly reported manifestations of bevacizumab-related nephrotoxicity with the risk increasing along with the dose and with the concomitant use of bisphosphonates. We describe the first case of a patient with small-cell lung cancer who developed diffuse extracapillary necrotizing crescentic glomerulonephritis, temporarily necessitating haemodialysis, following administration of bevacizumab and zolendronate. Renal function improved without any specific treatment and the patient remained off dialysis after withdrawal of bevacizumab-zolendronate. Special caution is required when VEGF inhibitors are combined with bisphosphonates. Such a combination can cause crescentic necrotizing glomerular lesions. Withdrawal of the offending medications may be adequate for the alleviation of this severe glomerulonephritis.
贝伐珠单抗是一种血管内皮生长因子 (VEGF) 抑制剂，已广泛应用于多种恶性肿瘤，为患者带来了显著的临床获益。高血压和蛋白尿是贝伐珠单抗相关肾毒性最常报告的表现，其风险随着剂量的增加和与双膦酸盐的联合应用而增加。我们描述了首例小细胞肺癌患者在接受贝伐珠单抗和唑来膦酸治疗后发生弥漫性毛细血管外坏死性新月体肾小球肾炎的病例，该患者曾短暂需要血液透析。停用贝伐珠单抗-唑来膦酸后，肾功能无明显改善，患者无需继续透析。当 VEGF 抑制剂与双膦酸盐联合使用时需要特别小心。这种组合可能会导致新月体坏死性肾小球病变。停用引起这种严重肾小球肾炎的药物可能足以缓解这种疾病。
