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Abstract: FR-PO199

A Rare Case of Membranoproliferative Glomerulonephritis (MPGN) With Bevacizumab

Session Information

Category: Onconephrology

  • 1600 Onconephrology

Authors

  • Shenoy, Prashamsa, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
  • Li, Li, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
  • Zhang, JingJing, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
Introduction

Bevacizumab is an anti-VEGF target chemotherapy often associated with proteinuria, hypertension and thrombotic microangiopathy (TMA). We report a case of immune complex-mediated membranoproliferative glomerulonephritis (IC-MPGN) following bevacizumab therapy.

Case Description

A 58-year-old female patient diagnosed with endometrial carcinoma 4 years ago presented with a persistent rise in creatinine (Cr) to 1.4 from 0.7 baseline, while on bevacizumab 15mg/Kg/3 weeks for 10 months. She was previously treated with carboplatin, paclitaxel, docetaxel, bevacizumab and dexamethasone. Her urinalysis showed 1+ proteinuria, sterile pyuria and persistent eosinophilia. Bevacizumab was discontinued and kidney biopsy was pursued. Work up including ANA, ANCA, dsDNA, anti-Ro/ La, complements, hepatitis and HIV serologies were unremarkable.
Biopsy revealed thickening of glomerular basement membrane (GBM), endocapillary and mesangial hypercellularity with lobulated pattern consistent with MPGN (Fig A). There was focal double contouring of the GBM but no evidence of fibrinoid necrosis or thrombi. Immunofluorescence (IF) showed capillary wall staining for IgG, IgA, IgM, C3, C1q, kappa and lambda in 2-3+ range. Electron microscopy demonstrated extensive subendothelial and mesangial electron-dense deposits (EDD) with mild podocytopathy (Fig B). The overall features diagnostic of IC-MPGN.
She was started on prednisone 40mg, tapered in 3 months with improvement in Cr, proteinuria and remained stable despite switching to pembrolizumab and lenvatinib.

Discussion

Bevacizumab is often associated with TMA developing within a year and demonstrates endothelial swelling, mesangiolysis and fibrinoid necrosis. This case had classic IC-MPGN with full house IF and EDD, perplexing us if the culprit was bevacizumab or the solid tumor itself. But her kidney injury was temporally related to bevacizumab and followed discontinuation of dexamethasone suggesting potential development of antibodies to bevacizumab. Therefore, clinicians should be vigilant and practice low threshold for biopsy with patients on bevacizumab for appropriate management.