Bevacizumab-induced immunoglobulin A vasculitis with nephritis

Endo, Yoko; Negishi, Kousuke; Hirayama, Kento; Suzuki, Hitoshi; Shimizu, Akira

doi:10.1097/md.0000000000017870

Cited by 11 publications

(9 citation statements)

References 17 publications

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“…Others mention drug-related IgAV in patients treated with vascular endothelial growth factor or immune checkpoint inhibitor. 16 , 17 Three cases of solid-organ malignancy diagnosed as HSP were instructive. Two had complete remission with a combination of immunosuppressive therapies for HSP and treatment of the associated malignancy.…”

Section: Discussionmentioning

confidence: 99%

IgA Vasculitis in a Lung Cancer Patient During Chemoradiotherapy

Taoka¹,

Ochi²,

Mimura³

et al. 2021

TCRM

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A 72-year-old man with locally advanced lung squamous cell carcinoma experienced red purpura on the lower legs and hematuria when the disease progressed during definitive chemoradiotherapy. He had renal dysfunction and proteinuria. Biopsy specimens of the skin lesion and kidney revealed immunoglobulin A vasculitis. Potential causes such as paraneoplastic syndrome and cancer treatment have been proposed. The administration of steroids rapidly improved the symptoms. The presentation of immunoglobulin A vasculitis is accompanied by malignancies. Clinicians should keep this syndrome in mind, even during curative-intent treatment.

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Section: Discussionmentioning

confidence: 99%

IgA Vasculitis in a Lung Cancer Patient During Chemoradiotherapy

Taoka¹,

Ochi²,

Mimura³

et al. 2021

TCRM

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“…4 IgA deposits in patients with bevacizumab-induced TMA have also been described. 5,6 It is hypothesized that bevacizumab increases interstitial mucosal permeability and the production of mucosal IgA, and these IgA deposits are trapped by damaged capillaries. 5,6 A link between these 2 differing lesions (TMA and IgA deposition) may be possible but presently remains speculative.…”

Section: What Is the Pathophysiology Of The Most Likely Renal Lesion?mentioning

confidence: 99%

New-Onset Proteinuria in a Patient With Schwannoma

Salman

Kallis²,

Palmer

et al. 2021

American Journal of Kidney Diseases

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A 29-year-old male patient with a history of neurofibromatosis type II and bilateral vestibular schwannomas was referred for evaluation of new-onset proteinuria. The patient's schwannomas were inoperable, and he was treated with bevacizumab 10 mg/kg intravenously every 3 weeks. After 18 months of therapy, serial imaging showed stabilization of the schwannoma size and sequential monitoring of urine analyses showed newonset proteinuria without changes in kidney function. Bevacizumab was discontinued and he was referred for nephrology evaluation. His physical examination was notable for elevated blood pressure (153/93 mm Hg) but was otherwise unremarkable. Laboratory evaluation included complement concentrations; serum-free light chain levels; serum and urine protein electrophoresis; and antinuclear antibody, antineutrophil cytoplasmic antibody, hepatitis B virus, hepatitis C virus, HIV, and anti-M-type phospholipase A 2 receptor serologies; all were noncontributory. Urine dipstick gave negative results for blood and urine microscopy examination was unremarkable. The patient was treated conservatively with an angiotensin receptor blocker. Six months later, there was no improvement in his proteinuria and a kidney biopsy was performed (Fig 1).

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“…IgAV is known to occur following infection and is referred to as a “seasonal” disease demonstrated by an epidemiological peak in autumn and winter in children and spring and summer in adults (García-Porrúa et al, 2002 ). In most patients, a virus, bacteria or a drug is a trigger leading to the onset of vasculitis (Brandy-García et al, 2020 ; Endo et al, 2019 ; Itoh et al, 2020 ; Mazumder et al, 2020 ). In adults, IgAV diagnosis is based upon clinical symptoms and laboratory parameters as well as the analysis of a histological sample, e.g., skin or kidney sample which may show IgA deposits.…”

Section: Introductionmentioning

confidence: 99%

A specific diagnostic metabolome signature in adult IgA vasculitis

Boissais,

Blasco,

Emond

et al. 2024

Metabolomics

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Introduction IgA vasculitis diagnosis relies primarily on clinical features and is confirmed by pathological findings. To date, there is no reliable noninvasive diagnostic biomarker. Objective We aimed to explore the baseline serum metabolome of adult patients with IgA vasculitis to identify potential diagnostic biomarkers. Methods We performed a study comparing the serum metabolome of patients with IgA vasculitis to that of patients with inflammatory condition, namely spondyloarthritis. Serum analyses were performed by high-performance liquid chromatography-mass spectrometry. Results Fifty-five patients with IgA vasculitis and 77 controls with spondyloarthritis (age- and sex-matched) were included in this study. The median age of IgA vasculitis patients was 53 years. Two-thirds of patients were female (n = 32). At the time of vasculitis diagnosis, 100% of patients had skin involvement and 69% presented with glomerulonephritis (n = 38). Joint and digestive involvement were observed in 56% (n = 31) and 42% (n = 23) of patients. Four discriminative metabolites between the two groups were identified: 1-methyladenosine, L-glutamic acid, serotonin, and thymidine. The multivariate model built from the serum metabolomes of patients with IgA vasculitis and spondyloarthritis revealed an accuracy > 90%. As this model was significant according to the permutation test (p < 0.01), independent validation showed an excellent predictive value of the test set: sensitivity 98%; specificity 98%, positive predictive value 97% and negative predictive value 98%. Conclusion To our knowledge, this study is the first to use the metabolomic approach for diagnostic purposes in adult IgA vasculitis, highlighting a specific diagnostic metabolome signature.

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Bevacizumab-induced immunoglobulin A vasculitis with nephritis

Cited by 11 publications

References 17 publications

IgA Vasculitis in a Lung Cancer Patient During Chemoradiotherapy

IgA Vasculitis in a Lung Cancer Patient During Chemoradiotherapy

New-Onset Proteinuria in a Patient With Schwannoma

A specific diagnostic metabolome signature in adult IgA vasculitis

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