Logo-jnp
J Nephropathol. 2017;6(3): 134-137.
doi: 10.15171/jnp.2017.23
PMID: 28975092
PMCID: PMC5607973
Scopus ID: 85019925033
  Abstract View: 4140
  PDF Download: 2298

Case Report

Self-limited membranous nephropathy after intravitreal bevacizumab therapy for age-related macular degeneration

Gebran Khneizer, Ahmad Al-Taee, Bahar Bastani*

1 Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
*Corresponding Author: *Corresponding author: Prof. Bahar Bastani, Division of Nephrology, Saint Louis University Health Science Center, Saint Louis. , Email: bastanib@slu.edu

Abstract

Background: Monoclonal antibodies targeting vascular endothelial growth factor (VEGF), such as bevacizumab, are administered intravitreally for the treatment of wet or exudative age-related macular degeneration (ARMD). Systemic use of bevacizumab has been linked to a wide range of renal adverse effects including proteinuria and hypertension.

Case Presentation: We present the case of a 77-year-old Caucasian male with a past medical history of hypertension, vitamin D deficiency and paroxysmal atrial fibrillation who presented to primary care clinic with a 2-week history of bilateral lower extremity edema, 2 months after completing four monthly intravitreal injections of bevacizumab for ARMD. Examination was remarkable for blood pressure of 187/91 mm Hg and severe bilateral lower extremity edema. Work up revealed unremarkable complete blood count (CBC), comprehensive metabolic panel (CMP), lipid panel, and echocardiography, except for 491 mg/dL albuminuria. Metoprolol and furosemide were added to hydrochlorothiazide and lisinopril. Work up by nephrology consult team five months later was notable for a urinalysis revealing 3 red blood cells/high power field (RBC/HPF), 24-hour urine protein of 8.6 g, and serum creatinine of 1.2 mg/dL. Viral hepatitis panel, total complement activity (CH50), C3, C4, anti-nuclear antibody (ANA), anti-neutrophil cytoplasmic antibody (ANCA), serum and urine protein electrophoresis were all unremarkable. Renal biopsy was consistent with membranous nephropathy. Age-appropriate cancer screening was negative. Random urine protein-to-creatinine ratio declined to 2 g/g and then to 0.56 g/g at 7 and 10 months follow up, respectively. Serum blood urea nitrogen (BUN) and creatinine remained normal throughout the course of illness and patient did not require any immunosuppressive treatment.

Conclusions: The wide range of nephrotoxicity after systemic bevacizumab has been well documented. Our case describes a self-limited biopsy-proven membranous nephropathy after intravitreal bevacizumab injections.


Implication for health policy/practice/research/medical education:

Clinicians need to be familiar with the renal side effects of intravitreal anti-VEGF particularly bevacizumab in the setting of growing use of such medications.

Please cite this paper as: Khneizer G, Al-Taee A, Bastani B. Self-limited membranous nephropathy after intravitreal bevacizumab therapy for age-related macular degeneration. J Nephropathol. 2017;6(3):134-137. DOI: 10.15171/jnp.2017.23.

First Name
 
Last Name
 
Email Address
 
Comments
 
Security code


Abstract View: 4141

Your browser does not support the canvas element.


PDF Download: 2298

Your browser does not support the canvas element.

ePublished: 05 Feb 2017
EndNote EndNote

(Enw Format - Win & Mac)

BibTeX BibTeX

(Bib Format - Win & Mac)

Bookends Bookends

(Ris Format - Mac only)

EasyBib EasyBib

(Ris Format - Win & Mac)

Medlars Medlars

(Txt Format - Win & Mac)

Mendeley Web Mendeley Web
Mendeley Mendeley

(Ris Format - Win & Mac)

Papers Papers

(Ris Format - Win & Mac)

ProCite ProCite

(Ris Format - Win & Mac)

Reference Manager Reference Manager

(Ris Format - Win only)

Refworks Refworks

(Refworks Format - Win & Mac)

Zotero Zotero

(Ris Format - Firefox Plugin)