Thrombotic Microangiopathy and Acute Kidney Injury Induced After Intravitreal Injection of Vascular Endothelial Growth Factor Inhibitors VEGF Blockade-Related TMA After Intravitreal Use

Frontiers in Medicine

article

Ramy M. Hanna¹  Marina Barsoum²  Vanesa Bijol³  Kamyar Kalantar-Zadeh¹  Alex Pai¹  Alpesh Amin⁴  Baruch Kupperman⁵  Ira B. Kurtz⁶  Ngoc-Tram Tran⁸  Sapna S. Patel⁸  Jean Hou⁹  Kenar D. Jhaveri^1,10  Rushang Parikh^1,10  Umut Selamet^1,11  Lena Ghobry^1,12  Olivia Wassef⁶ 

[1] Division of Nephrology, Department of Medicine, University of California (UC) Irvine School of Medicine, United States;Keck School of Science and Technology, School of Pharmacy, Chapman University, United States;Department of Pathology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States;Department of Medicine, University of California (UC) Irvine, United States;Herbert Gavin Eye Institute, Department of Ophthalmology, University of California (UC) Irvine, United States;Division of Nephrology, Department of Medicine, University of California, United States;Brain Research Institute, University of California Los Angeles (UCLA), United States;Division of Nephrology, Department of Medicine, Long Beach Memorial Medical Center, United States;Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, United States;Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States;Division of Renal Medicine, Department of Internal Medicine, Brigham and Women's Hospital, United States;School of Public Health, University of Pittsburgh, United States

关键词: intravitreal injections;    thrombotic microangiopathy;    diabetic retinopathy;    vascular endothelial growth factor (VEGF);    bevacizumab (avastin);    ranibizumab (Lucentis);    aflibercept (Eylea);   

DOI  :  10.3389/fmed.2020.579603

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Vascular endothelial growth factor (VEGF) inhibition can cause worsening hypertension, proteinuria, chronic kidney injury, and glomerular disease. Thrombotic microangiopathy (TMA) and other nephrotic disorders have been reported with systemic VEGF blockade. These same agents are given intravitreally for age-related macular degeneration (AMD) and diabetic retinopathy (DR), albeit at lower doses than those given for systemic indications. Systemic absorption of anti-VEGF agents when given intravitreally has been shown consistently along with evidence of significant intravascular VEGF suppression. While worsening hypertension has only been seen in some large-scale studies, case reports show worsening proteinuria and diverse glomerular diseases. These include TMA-associated lesions like focal and segmental glomerulosclerosis with collapsing features (cFSGS). In this paper, we report three cases of TMA likely associated with the use of intravitreal anti-VEGF therapy. These patients developed the signature lesion of VEGF blockade in a 6 to 11 month time frame after starting intravitreal VEGF inhibitors. The literature is reviewed showing similar cases. Intravitreal VEGF blockade may cause these adverse events in a hitherto unidentified subgroup of patients. Well-controlled prospective observational trials are needed to determine the event rate and identify which subgroups of patients are at increased risk. A registry for patients who develop worsening hypertension, proteinuria exacerbation, and glomerular diseases from intravitreal VEGF blockade is proposed.

【 授权许可】

CC BY