Membranoproliferative glomerulonephritis after intravitreal vascular growth factor inhibitor injections: A case report and review of the literature

Abstract

Systemic administration of agents that inhibit vascular endothelial growth factor (VEGF) and therefore vascular proliferation is often used to treat various cancers. However, these agents are associated with a number of side effects, including proteinuria and renal injury. Intravitreal injection of anti‐VEGF agents has become the cornerstone of macular disease treatment. Since these agents cross the blood‐retina barrier and enter the circulation, systemic side effects have been reported. We report the novel case of a 57‐year‐old patient who presented with macular oedema secondary to central retinal vein occlusion, underwent three monthly loading‐dose injections with the anti‐VEGF agent ranibizumab, and 2 weeks after the second injection presented with biopsy‐verified membranoproliferative glomerulonephritis. Twelve weeks after presenting with renal failure and 10 weeks after his last anti‐VEGF injection, the patient demonstrated spontaneous recovery of his kidney function. The patient had a history that promoted renal fragility, including hypertension, liver transplantation 6 years earlier for alcohol‐related cirrhosis and new‐onset diabetes mellitus after transplant. Our literature review and case suggest that although adverse renal events after intravitreal anti‐VEGF injections are very rare, ophthalmologists and nephrologists should be aware of this risk.

Farmacoterapia e evolução clínica de pacientes com degeneração macular relacionada à idade em tratamento com Ranibizumabe

“…(2006) encontraram em seus resultados que a perda da visão foi prevenida e a acuidade visual média de pacientes teve melhora com baixa taxa de eventos adversos e Bandello et al (2019) encontraram em um estudo sobre a segurança terapêutica do Ranibizumabe que houve poucos eventos adversos no uso desse medicamento, demonstrando sua segurança e tolerabilidade. Porém em um relato de caso Gan, et. al.…”

“…al. (2022) relataram que um paciente de 57 anos em tratamento com Ranibizumabe para oclusão da veia central da retina apresentou glomerulonefrite após duas semanas da injenção do anti-VEGF (Gan et al, 2022).…”

Administration of Bevacizumab and the Risk of Chronic Kidney Disease Development in Taiwan Residents: A Population-Based Retrospective Cohort Study

“…Patients with extremely high or low eGFR have greater persistent eGFR decline during the long-term intravitreal administration of anti-VEGF treatment for two years in the patients with diabetic macular edema [ 29 ]. Gan et al reported that a patient with macular edema secondary to central retinal vein occlusion has membranoproliferative glomerulonephritis after intravitreal vascular growth factor inhibitor injections [ 30 ]. However, there is no clinically significant change in the serum markers of renal function during the short-term intravitreal treatment of anti-VEGF drugs for 1 month in the patients with neovascular age-related macular degeneration [ 31 ].…”

“…Uys et al reported that continuous bevacizumab use led to renal thrombotic microangiopathy (TMA) [ 38 ]. In addition, several cases of renal dysfunction and proteinuria have been reported after exposure to bevacizumab [ 26 , 27 , 28 , 30 , 32 ]. A previous study suggested that TMA was associated with a risk of CKD [ 39 ].…”