Plasma exchange for treatment of a therapy‐related thrombotic microangiopathy in a patient with advanced hepatocellular carcinoma—A case report
Key Clinical Message Thrombotic microangiopathies are a side effect of anti‐VEGF therapies, which are often limited to the kidneys but can also occur systemically and be life‐threatening. Screening for increasing proteinuria is essential. Abstract We present the case of a 65‐year‐old male patient wi...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-11-01
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| Series: | Clinical Case Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ccr3.8124 |
| _version_ | 1827631971019259904 |
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| author | Marco Stortz Kateryna Shmanko Daniel Kraus Simon Gairing Simone Boedecker‐Lips Friederich Förster Arndt Weinmann Julia Weinmann‐Menke |
| author_facet | Marco Stortz Kateryna Shmanko Daniel Kraus Simon Gairing Simone Boedecker‐Lips Friederich Förster Arndt Weinmann Julia Weinmann‐Menke |
| author_sort | Marco Stortz |
| collection | DOAJ |
| description | Key Clinical Message Thrombotic microangiopathies are a side effect of anti‐VEGF therapies, which are often limited to the kidneys but can also occur systemically and be life‐threatening. Screening for increasing proteinuria is essential. Abstract We present the case of a 65‐year‐old male patient with a multifocal HCC, Barcelona clinic liver cancer (BCLC) classification B at the time of diagnosis. The HCC was treated with nine sessions of transarterial chemoembolization (TACE), and after a progress, the therapy was switched to a combination of atezolizumab and bevacizumab. Five months after therapy change, he presented with an acute kidney injury. The histopathology of the renal biopsy showed findings of a thrombotic microangiopathy (TMA), which we treated with 12 sessions of therapeutic plasma exchange in combination with steroids, resulting in a decreased TMA activity and later in a remission of the TMA. This case suggests the importance of monitoring the kidney function and proteinuria in patients under anti‐vascular endothelial growth factor (VEGF) therapy and shows a rare differential diagnosis for a worsening of kidney function in these patients. Furthermore, it shows that therapeutic plasma exchange might be a valuable therapeutic option for patients with TMA due to anti‐VEGF therapy. |
| first_indexed | 2024-03-09T14:29:35Z |
| format | Article |
| id | doaj.art-3a40586195b940a099722aee954ea81f |
| institution | Directory Open Access Journal |
| issn | 2050-0904 |
| language | English |
| last_indexed | 2024-03-09T14:29:35Z |
| publishDate | 2023-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Clinical Case Reports |
| spelling | doaj.art-3a40586195b940a099722aee954ea81f2023-11-28T04:14:45ZengWileyClinical Case Reports2050-09042023-11-011111n/an/a10.1002/ccr3.8124Plasma exchange for treatment of a therapy‐related thrombotic microangiopathy in a patient with advanced hepatocellular carcinoma—A case reportMarco Stortz0Kateryna Shmanko1Daniel Kraus2Simon Gairing3Simone Boedecker‐Lips4Friederich Förster5Arndt Weinmann6Julia Weinmann‐Menke7Department of Nephrology, Department for Internal Medicine University Medical Center Mainz Mainz GermanyDepartment for Internal Medicine University Medical Center Mainz Mainz GermanyDepartment of Nephrology, Department for Internal Medicine University Medical Center Mainz Mainz GermanyDepartment for Internal Medicine University Medical Center Mainz Mainz GermanyDepartment of Nephrology, Department for Internal Medicine University Medical Center Mainz Mainz GermanyDepartment for Internal Medicine University Medical Center Mainz Mainz GermanyDepartment for Internal Medicine and Clinical Registry Unit University Medical Center Mainz Mainz GermanyDepartment of Nephrology, Department for Internal Medicine University Medical Center Mainz Mainz GermanyKey Clinical Message Thrombotic microangiopathies are a side effect of anti‐VEGF therapies, which are often limited to the kidneys but can also occur systemically and be life‐threatening. Screening for increasing proteinuria is essential. Abstract We present the case of a 65‐year‐old male patient with a multifocal HCC, Barcelona clinic liver cancer (BCLC) classification B at the time of diagnosis. The HCC was treated with nine sessions of transarterial chemoembolization (TACE), and after a progress, the therapy was switched to a combination of atezolizumab and bevacizumab. Five months after therapy change, he presented with an acute kidney injury. The histopathology of the renal biopsy showed findings of a thrombotic microangiopathy (TMA), which we treated with 12 sessions of therapeutic plasma exchange in combination with steroids, resulting in a decreased TMA activity and later in a remission of the TMA. This case suggests the importance of monitoring the kidney function and proteinuria in patients under anti‐vascular endothelial growth factor (VEGF) therapy and shows a rare differential diagnosis for a worsening of kidney function in these patients. Furthermore, it shows that therapeutic plasma exchange might be a valuable therapeutic option for patients with TMA due to anti‐VEGF therapy.https://doi.org/10.1002/ccr3.8124bevacizumabHCCplasma exchangethrombotic microangiopathy |
| spellingShingle | Marco Stortz Kateryna Shmanko Daniel Kraus Simon Gairing Simone Boedecker‐Lips Friederich Förster Arndt Weinmann Julia Weinmann‐Menke Plasma exchange for treatment of a therapy‐related thrombotic microangiopathy in a patient with advanced hepatocellular carcinoma—A case report Clinical Case Reports bevacizumab HCC plasma exchange thrombotic microangiopathy |
| title | Plasma exchange for treatment of a therapy‐related thrombotic microangiopathy in a patient with advanced hepatocellular carcinoma—A case report |
| title_full | Plasma exchange for treatment of a therapy‐related thrombotic microangiopathy in a patient with advanced hepatocellular carcinoma—A case report |
| title_fullStr | Plasma exchange for treatment of a therapy‐related thrombotic microangiopathy in a patient with advanced hepatocellular carcinoma—A case report |
| title_full_unstemmed | Plasma exchange for treatment of a therapy‐related thrombotic microangiopathy in a patient with advanced hepatocellular carcinoma—A case report |
| title_short | Plasma exchange for treatment of a therapy‐related thrombotic microangiopathy in a patient with advanced hepatocellular carcinoma—A case report |
| title_sort | plasma exchange for treatment of a therapy related thrombotic microangiopathy in a patient with advanced hepatocellular carcinoma a case report |
| topic | bevacizumab HCC plasma exchange thrombotic microangiopathy |
| url | https://doi.org/10.1002/ccr3.8124 |
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