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Renal effects of anti-angiogenesis therapy: update for the internist

Faina Gurevich1, Mark A Perazella

  • 1Department of Medicine, Yale University School of Medicine, New Haven, CT 06520-8029, USA.

The American Journal of Medicine
|April 1, 2009
PubMed

Insights

Anti-vascular endothelial growth factor (VEGF) cancer therapies can cause kidney problems like proteinuria and acute kidney injury. Close monitoring is essential for managing these adverse effects in patients undergoing anti-VEGF treatment.

Area of Science:

  • Oncology
  • Nephrology
  • Pharmacology

Background:

  • Angiogenesis is a key target in cancer therapy.
  • Vascular Endothelial Growth Factor (VEGF) inhibitors are widely used in cancer treatment.
  • These drugs can cause significant renal side effects.

Purpose of the Study:

  • To review the renal effects of anti-VEGF therapies.
  • To discuss the mechanisms behind these adverse events.
  • To emphasize the importance of monitoring patients on anti-VEGF drugs.

Main Methods:

  • Literature review of studies on anti-VEGF drugs and renal effects.
  • Analysis of histopathological findings in affected patients.
  • Discussion of proposed pathogenetic mechanisms for hypertension and glomerular injury.

Main Results:

  • Common side effects include mild proteinuria and hypertension.
  • High-grade proteinuria and acute kidney injury can occur.
  • Thrombotic microangiopathy is the most frequent kidney lesion observed.
  • Other lesions include glomerular injury and interstitial nephritis.

Conclusions:

  • Anti-VEGF therapies present unique renal challenges.
  • Mechanisms involve nitric oxide pathway inhibition, rarefaction, and oxidative stress.
  • Glomerular injury may stem from impaired filtration barrier maintenance.
  • Adverse effects are manageable with careful patient management and follow-up.

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