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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...