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Ocular and systemic vascular endothelial growth factor ligand inhibitor use and nephrotoxicity: an update
Dharshan Rangaswamy1, Shankar Prasad Nagaraju1, Mohan Varadanayakanahalli Bhojaraja1
1Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India.
Abstract:
Tumor growth is intricately linked to the process of angiogenesis, with a key role played by vascular endothelial growth factor (VEGF) and its associated signaling pathways. Notably, these pathways also play a pivotal "housekeeping" role in renal physiology. Over the past decade, the utilization of VEGF signaling inhibitors has seen a substantial rise in the treatment of diverse solid organ tumors, diabetic retinopathy, age-related macular degeneration, and various ocular diseases. However, this increased use of such agents has led to a higher frequency of encountering renal adverse effects in clinical practice. This review comprehensively addresses the incidence, pathophysiological mechanisms, and current evidence concerning renal adverse events associated with systemic and intravitreal antiangiogenic therapies targeting VEGF-A and its receptors (VEGFR) and their associated signaling pathways. Additionally, we briefly explore strategies for mitigating potential risks linked to the use of these agents and effectively managing various renal adverse events, including but not limited to hypertension, proteinuria, renal dysfunction, and electrolyte imbalances.
Insights
Vascular endothelial growth factor (VEGF) inhibitors treat cancers and eye diseases but can cause kidney problems. This review details these renal adverse events and management strategies.
Area of Science:
- Oncology
- Nephrology
- Ophthalmology
Background:
- Tumor growth relies on angiogenesis, driven by vascular endothelial growth factor (VEGF).
- VEGF pathways are crucial for normal kidney function.
- Anti-VEGF therapies are widely used for cancers and eye conditions.
Purpose of the Study:
- To review renal adverse events linked to anti-VEGF therapies.
- To explore the mechanisms and incidence of these kidney-related side effects.
- To discuss management and risk mitigation strategies.
Main Methods:
- Comprehensive literature review of studies on anti-VEGF agents.
- Analysis of pathophysiological mechanisms of renal adverse events.
- Examination of clinical evidence regarding incidence and management.
Main Results:
- Increased use of VEGF inhibitors correlates with more frequent renal adverse effects.
- Common renal issues include hypertension, proteinuria, dysfunction, and electrolyte imbalances.
- Systemic and intravitreal anti-VEGF therapies pose risks to renal physiology.
Conclusions:
- Anti-VEGF therapies, while effective, necessitate careful monitoring for renal complications.
- Understanding mechanisms aids in predicting and managing adverse events.
- Proactive management strategies are essential for patient safety.
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