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Anti-VEGF Effect

This biopsy was taken from an older adult man with acute kidney injury and non-nephrotic range proteinuria.  His medical history included metastatic colonic adenocarcinoma, for which he was taking bevacizumab, an anti-vascular endothelial growth factor (anti-VEGF) inhibitor.  The sampled glomeruli show changes of thrombotic microangiopathy (TMA), including double contour formation of glomerular capillaries (Fig. 1) and intracapillary red blood cell fragmentation (Fig. 2).  TMA is one of the most common adverse effects in the kidney of bevacizumab therapy, and it has been reported as early as one week after starting the drug.  Other pathologies reported in the setting of anti-VEGF...

Vascular Endothelial Growth Factor

The biopsy shown here is from a seven-year-old female with nephrotic syndrome. Her serum Cr was increased to 0.9 mg/dl and her urine protein/creatinine ratio was 7. She was s/p nephrectomy for renal cell carcinoma and had been treated with bevacizumab for six months prior to the biopsy. Serum C3 and C4 levels were normal and her platelet count was also normal. On biopsy, glomeruli show extensive basement membrane duplication and segmental hyalinosis of the glomerular tuft (arrow). These glomerular changes are characteristic of VEGF inhibitor-associated glomerulopathy. There is evidence to suggest that VEGF production by podocytes is required for...