Sharma Sourabh, Venkatesh Pradeep, Kalra Sanjay, Verma Himanshu, Kapoor Nitin, Nagendra Lakshmi, Unnikrishnan A G, Prakash Sudeep, Sahay Manisha, Hada Maya, Kumawat Devesh, Raju Sree Bhushan, Tandon Radhika
Department of Nephrology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India.
Retina and Uvea Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Diabetes Ther. 2025 Sep 11. doi: 10.1007/s13300-025-01791-y.
Intravitreal therapy using anti-vascular endothelial growth factor (anti-VEGF) has transformed the approach to treating diabetic retinopathy (DR), but its application in individuals with diabetes and chronic kidney disease, the majority of whom have diabetic kidney disease, involves a complex evaluation of risks and benefits. Emerging evidence indicates that the systemic absorption of anti-VEGF agents administered intravitreally may lower circulating VEGF levels and negatively impact the renal endothelium, especially in individuals with pre-existing kidney issues. In this article, we showcase an evidence-based framework for the safe administration of anti-VEGF therapy in patients with DR accompanied by chronic kidney disease. We introduce a novel renoretinal syndrome, which we refer to as anti-VEGF-associated nephropathy (AVAN), and outline diagnostic criteria, severity classifications, biopsy indications, and treatment recommendations to guide clinical practice.
使用抗血管内皮生长因子（anti-VEGF）的玻璃体内注射疗法改变了糖尿病视网膜病变（DR）的治疗方法，但其在糖尿病和慢性肾脏病患者（其中大多数患有糖尿病肾病）中的应用涉及对风险和益处的复杂评估。新出现的证据表明，玻璃体内注射的抗VEGF药物的全身吸收可能会降低循环VEGF水平，并对肾内皮产生负面影响，尤其是在已有肾脏问题的个体中。在本文中，我们展示了一个基于证据的框架，用于在伴有慢性肾脏病的DR患者中安全地给予抗VEGF治疗。我们引入了一种新的肾视网膜综合征，我们称之为抗VEGF相关性肾病（AVAN），并概述了诊断标准、严重程度分类、活检指征和治疗建议，以指导临床实践。
