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Systemic and kidney toxicity of intraocular administration of vascular endothelial growth factor inhibitors

Gaëlle Pellé1, Nasim Shweke, Jean-Paul Duong Van Huyen

  • 1Service de néphrologie-transplantation rénale, Hôpital Foch, Suresnes, France. g.pelle@hopital-foch.org

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|February 8, 2011
PubMed

Insights

Intravitreal anti-VEGF injections, used for eye conditions, may cause kidney damage. This case report highlights acute kidney injury and hemolytic anemia following ranibizumab treatment, urging awareness among physicians.

Area of Science:

  • Nephrology
  • Ophthalmology
  • Oncology

Background:

  • Angiogenesis inhibitors administered intravenously are standard cancer treatments, with known renal side effects like proteinuria, hypertension, and thrombotic microangiopathies.
  • Intravitreal anti-vascular endothelial growth factor (VEGF) injections are common for neovascular age-related macular degeneration.
  • Systemic absorption of intravitreal anti-VEGF agents poses a risk to VEGF-dependent organs, including the kidneys.

Observation:

  • A patient developed acute kidney injury, nonimmune microangiopathic hemolytic anemia with schistocytes, and thrombocytopenia.
  • These complications occurred after receiving four intravitreal injections of ranibizumab.

Findings:

  • Kidney biopsy revealed segmental glomerular basement membrane duplications, endothelial swelling, and recanalized arteriolar thrombi.
  • The findings suggest a link between intravitreal ranibizumab and thrombotic microangiopathy affecting the kidneys.

Implications:

  • Ophthalmologists and nephrologists must recognize the potential for renal complications associated with increasing use of intravitreal anti-VEGF therapies.
  • Early identification and cessation of these injections are critical to prevent severe kidney disease progression.

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