Division of Nephrology, Sakai City Medical Center, 1-1-1 Ebaraji-cho, Nishi-ku, Sakai, Osaka, Japan.
Department of Pathology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, Japan.
CEN Case Rep. 2021 Feb;10(1):6-11. doi: 10.1007/s13730-020-00504-7. Epub 2020 Jul 8.
Bevacizumab is a monoclonal antibody against vascular endothelial growth factor (VEGF) that is used to treat patients with various cancers. However, it is known to be associated with adverse events, such as hypertension and proteinuria. The histology of bevacizumab-induced nephropathy is known as thrombotic microangiopathy or minimal change nephrotic syndrome. Recently, however, the terms "bevacizumab-associated glomerular microangiopathy" and "anti-VEGF therapy-induced glomerular microangiopathy" have been proposed. We present a case of a 68-year-old woman who was administered postoperative chemotherapy (carboplatin, paclitaxel, and bevacizumab) for stage IV ovarian cancer. Proteinuria and hypertension appeared after three courses; however, six courses were completed. Then, gemcitabine and carboplatin were administered for recurrence of her cancer. She was diagnosed with nephrotic syndrome after eight courses. Renal biopsy showed accumulation of periodic acid-Schiff (PAS)-positive substances in the capillary walls and para-mesangial areas. Double contouring of basement membranes was also observed. Immunofluorescence microscopy revealed positive staining for IgG, IgA, IgM, C3, C4, and C1q. Immunosuppressive therapy was administered, but was ineffective. Further examination by electron microscopy and immunostaining led to a diagnosis of bevacizumab-associated glomerular microangiopathy.
贝伐珠单抗是一种针对血管内皮生长因子 (VEGF) 的单克隆抗体，用于治疗各种癌症患者。然而，它已知与不良反应相关，如高血压和蛋白尿。贝伐珠单抗诱导的肾病的组织学表现为血栓性微血管病或微小病变性肾病综合征。然而，最近提出了“贝伐珠单抗相关性肾小球微血管病”和“抗 VEGF 治疗诱导的肾小球微血管病”这两个术语。我们报告了一例 68 岁女性，她因 IV 期卵巢癌接受术后化疗（卡铂、紫杉醇和贝伐珠单抗）。三个疗程后出现蛋白尿和高血压，但完成了六个疗程。然后，吉西他滨和卡铂用于治疗癌症复发。八个疗程后，她被诊断为肾病综合征。肾活检显示毛细血管壁和旁系膜区有 PAS 阳性物质积聚。也观察到基底膜的双层轮廓。免疫荧光显微镜显示 IgG、IgA、IgM、C3、C4 和 C1q 阳性染色。给予免疫抑制治疗，但无效。进一步的电子显微镜和免疫染色检查导致贝伐珠单抗相关性肾小球微血管病的诊断。
