Bevacizumab-induced thrombotic microangiopathy with acute renal injury. A clinical case

Angiogenesis plays a crucial role in the tissue tropism of malignant tumors, as well as determines metastasis and tumor progression. One of the key factors of vascular growth is signaling proteins of the vascular endothelial growth factor (VEGF) family. To date, clinical oncology has introduced several drugs that block messaging via the VEGF pathway. Blocking these signals leads to the disruption of tumor tropism and thus slows down its growth. One such drug is bevacizumab. However, several side effects of VEGF-pathway blockade were also described, including arterial hypertension, renal dysfunction, and proteinuria. There are reports on the development of thrombotic microangiopathy (TMA) and bleeding disorders during therapy with the anti-VEGF drugs group. The article presents a clinical case of a patient who received adjuvant polychemotherapy for colorectal cancer with bevacizumab. Treatment was complicated by KDIGO stage 3 acute kidney injury with features of thrombotic microangiopathy. On examination in our department, anuria, increased BUN level, signs of microangiopathic hemolytic anemia (increased LDH level, schizocytosis) and a significant increase in D-dimer level were noted. The course of the disease was complicated by recurrent intestinal bleeding. A colonoscopy revealed a new solid lesion of tumor growth in the caecum. Because of the unresectability of the tumor lesion, conservative hemostatic therapy was administered. The patient received renal replacement therapy with hemofiltration, and plasma exchange sessions were performed. In 15 days, diuresis was restored. To determine further management tactics, the patient was referred to oncologists. The difficulties of predicting acute kidney injury and of multidisciplinary management of patients with complications of anti-VEGF therapy are discussed in the article.

тромботическая микроангиопатия, анти-VEGF препарат, острое повреждение почек, колоректальный рак, thrombotic microangiopathy, anti-VEGF, acute kidney injury, colorectal cancer

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