Thrombotic Microangiopathy and Acute Kidney Injury Induced After Intravitreal Injection of Vascular Endothelial Growth Factor Inhibitors VEGF Blockade-Related TMA After Intravitreal Use
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...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-10-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fmed.2020.579603/full |
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| author | Ramy M. Hanna Ngoc-Tram Tran Sapna S. Patel Jean Hou Kenar D. Jhaveri Rushang Parikh Umut Selamet Lena Ghobry Olivia Wassef Marina Barsoum Vanesa Bijol Kamyar Kalantar-Zadeh Alex Pai Alpesh Amin Baruch Kupperman Ira B. Kurtz Ira B. Kurtz |
| author_facet | Ramy M. Hanna Ngoc-Tram Tran Sapna S. Patel Jean Hou Kenar D. Jhaveri Rushang Parikh Umut Selamet Lena Ghobry Olivia Wassef Marina Barsoum Vanesa Bijol Kamyar Kalantar-Zadeh Alex Pai Alpesh Amin Baruch Kupperman Ira B. Kurtz Ira B. Kurtz |
| author_sort | Ramy M. Hanna |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-14T10:10:19Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-14T10:10:19Z |
| publishDate | 2020-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-6adab79bd83c45deb5c75cd4426d978b2022-12-21T23:07:01ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2020-10-01710.3389/fmed.2020.579603579603Thrombotic Microangiopathy and Acute Kidney Injury Induced After Intravitreal Injection of Vascular Endothelial Growth Factor Inhibitors VEGF Blockade-Related TMA After Intravitreal UseRamy M. Hanna0Ngoc-Tram Tran1Sapna S. Patel2Jean Hou3Kenar D. Jhaveri4Rushang Parikh5Umut Selamet6Lena Ghobry7Olivia Wassef8Marina Barsoum9Vanesa Bijol10Kamyar Kalantar-Zadeh11Alex Pai12Alpesh Amin13Baruch Kupperman14Ira B. Kurtz15Ira B. Kurtz16Division of Nephrology, Department of Medicine, University of California (UC) Irvine School of Medicine, Orange, CA, United StatesDivision of Nephrology, Department of Medicine, Long Beach Memorial Medical Center, Long Beach, CA, United StatesDivision of Nephrology, Department of Medicine, Long Beach Memorial Medical Center, Long Beach, CA, United StatesDepartment of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, CA, United StatesDivision of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, United StatesDivision of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, United StatesDivision of Renal Medicine, Department of Internal Medicine, Brigham and Women's Hospital, Boston, MA, United StatesSchool of Public Health, University of Pittsburgh, Pittsburgh, PA, United StatesDivision of Nephrology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United StatesKeck School of Science and Technology, School of Pharmacy, Chapman University, Orange, CA, United StatesDepartment of Pathology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, United StatesDivision of Nephrology, Department of Medicine, University of California (UC) Irvine School of Medicine, Orange, CA, United StatesDivision of Nephrology, Department of Medicine, University of California (UC) Irvine School of Medicine, Orange, CA, United States0Department of Medicine, University of California (UC) Irvine, Orange, CA, United States1Herbert Gavin Eye Institute, Department of Ophthalmology, University of California (UC) Irvine, Irvine, CA, United StatesDivision of Nephrology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States2Brain Research Institute, University of California Los Angeles (UCLA), Los Angeles, CA, United StatesVascular 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.https://www.frontiersin.org/article/10.3389/fmed.2020.579603/fullintravitreal injectionsthrombotic microangiopathydiabetic retinopathyvascular endothelial growth factor (VEGF)bevacizumab (avastin)ranibizumab (Lucentis) |
| spellingShingle | Ramy M. Hanna Ngoc-Tram Tran Sapna S. Patel Jean Hou Kenar D. Jhaveri Rushang Parikh Umut Selamet Lena Ghobry Olivia Wassef Marina Barsoum Vanesa Bijol Kamyar Kalantar-Zadeh Alex Pai Alpesh Amin Baruch Kupperman Ira B. Kurtz Ira B. Kurtz 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 intravitreal injections thrombotic microangiopathy diabetic retinopathy vascular endothelial growth factor (VEGF) bevacizumab (avastin) ranibizumab (Lucentis) |
| title | Thrombotic Microangiopathy and Acute Kidney Injury Induced After Intravitreal Injection of Vascular Endothelial Growth Factor Inhibitors VEGF Blockade-Related TMA After Intravitreal Use |
| title_full | Thrombotic Microangiopathy and Acute Kidney Injury Induced After Intravitreal Injection of Vascular Endothelial Growth Factor Inhibitors VEGF Blockade-Related TMA After Intravitreal Use |
| title_fullStr | Thrombotic Microangiopathy and Acute Kidney Injury Induced After Intravitreal Injection of Vascular Endothelial Growth Factor Inhibitors VEGF Blockade-Related TMA After Intravitreal Use |
| title_full_unstemmed | Thrombotic Microangiopathy and Acute Kidney Injury Induced After Intravitreal Injection of Vascular Endothelial Growth Factor Inhibitors VEGF Blockade-Related TMA After Intravitreal Use |
| title_short | Thrombotic Microangiopathy and Acute Kidney Injury Induced After Intravitreal Injection of Vascular Endothelial Growth Factor Inhibitors VEGF Blockade-Related TMA After Intravitreal Use |
| title_sort | thrombotic microangiopathy and acute kidney injury induced after intravitreal injection of vascular endothelial growth factor inhibitors vegf blockade related tma after intravitreal use |
| topic | intravitreal injections thrombotic microangiopathy diabetic retinopathy vascular endothelial growth factor (VEGF) bevacizumab (avastin) ranibizumab (Lucentis) |
| url | https://www.frontiersin.org/article/10.3389/fmed.2020.579603/full |
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