Worsening of renal function and uncontrolled hypertension from intravitreal bevacizumab injections

Area of Science:

• Nephrology
• Ophthalmology
• Oncology

Background:

• Vascular endothelial growth factor (VEGF) inhibitors are crucial in treating cancers and ophthalmic conditions like diabetic retinopathy.
• Systemic administration of VEGF inhibitors is known to cause adverse effects, including hypertension, proteinuria, and renal dysfunction.
• Intravitreal injections of VEGF inhibitors (bevacizumab, aflibercept, ranibizumab) have been linked to thrombotic microangiopathy and glomerular diseases.

Observation:

• A patient receiving intravitreal bevacizumab for diabetic retinopathy was hospitalized.
• The patient presented with elevated blood pressure, nephrotic-range proteinuria, and declining renal function.
• These symptoms occurred despite the patient maintaining strict glycemic control.

Findings:

• The case illustrates a potential link between intravitreal VEGF inhibitors and severe renal complications.
• Worsening hypertension and nephrotic-range proteinuria were observed in the context of diabetic retinopathy treatment.
• Renal function deterioration occurred despite optimal diabetes management.

Implications:

• This case underscores the importance of monitoring renal function and blood pressure in patients receiving intravitreal VEGF inhibitors.
• Further research is warranted to elucidate the mechanisms behind VEGF inhibitor-induced nephrotoxicity.
• Clinicians should consider potential renal adverse effects when prescribing VEGF inhibitors for ophthalmic conditions.