Toriu Naoya, Sekine Akinari, Mizuno Hiroki, Hasegawa Eiko, Yamanouchi Masayuki, Hiramatsu Rikako, Hayami Noriko, Hoshino Junichi, Kawada Masahiro, Suwabe Tatsuya, Sumida Keiichi, Sawa Naoki, Takaichi Kenmei, Ohashi Kenichi, Fujii Takeshi, Matoba Shuichiro, Ubara Yoshifumi
Nephrology Center and Department of Rheumatology, Toranomon Hospital, Tokyo, Japan.
Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
Case Rep Oncol. 2019 Jun 4;12(2):391-400. doi: 10.1159/000500716. eCollection 2019 May-Aug.
An 88-year-old Japanese man received bevacizumab for colorectal cancer with liver and peritoneal metastasis, during which nephrotic range proteinuria occurred (7.66 g/day). Renal biopsy showed endothelial damage with subendothelial swelling and a double contour of the glomerular basement membrane, which indicated a diagnosis of thrombotic microangiopathy (TMA). After bevacizumab was stopped, proteinuria decreased to 1 g/day. During the clinical course, this patient had no extrarenal manifestations. This case suggests that renal injury induced by bevacizumab is characterized by nephrotic range proteinuria and histological TMA, and is a renal-limited condition that differs from systemic TMA related to thrombotic thrombocytopenic purpura.
一名88岁的日本男性因患有伴有肝和腹膜转移的结直肠癌接受了贝伐单抗治疗，在此期间出现了肾病范围蛋白尿（7.66克/天）。肾活检显示内皮损伤伴内皮下肿胀和肾小球基底膜双轨征，这提示诊断为血栓性微血管病（TMA）。停用贝伐单抗后，蛋白尿降至1克/天。在临床过程中，该患者无肾外表现。该病例表明，贝伐单抗所致肾损伤的特征为肾病范围蛋白尿和组织学TMA，是一种与血栓性血小板减少性紫癜相关的全身性TMA不同的肾脏局限性疾病。
