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Abstract: SA-PO233

Glomerular Pathology of Vascular Endothelial Growth Factor Inhibition: 12-Year Single-Center Experience

Session Information

Category: Onconephrology

  • 1700 Onconephrology


  • Charkviani, Mariam, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Chowdhury, Raad Bin Zakir, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Mignano, Salvatore E., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Buglioni, Alessia, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Alexander, Mariam P., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Herrmann, Sandra, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Vascular endothelial growth factor inhibitors (VEGF-I) are frequently used for cancer treatment. VEGF-I can cause proteinuria and acute kidney injury. Thrombotic microangiopathy (TMA) is common, but other glomerular pathologies are not well characterized. We aim to describe clinical characteristics and glomerular lesions associated with VEFG-I in a single center cohort.


We performed a retrospective chart review of patients treated with VGEF-I and underwent kidney biopsies from 2010 to 2022. Biopsy findings were reviewed by our pathologists.


Nineteen biopsies were performed during 2010-2022 for kidney dysfunction in patients treated with VEGF-I. Eleven/19 had complete data. The median age was 62 (IQR 58-66) years, and the most common malignancy was renal cell carcinoma. TMA was found on 8/11 biopsies. Proteinuria was the most common reason for biopsy in patients with TMA. Three patients presented with other lesions besides TMA. One had anti-phospholipase A2 receptor-negative membranous nephropathy and both VEGF-I and pembrolizumab were stopped. She received prednisone with improvement in proteinuria. Another patient had known cryoglobulinemia with nephrotic range proteinuria exacerbated by VEGF-I peaking at 11g/day. Despite stopping VEGF-I and treating with prednisone+rituximab, he progressed to ESKD. Third patient had IgA nephropathy with diabetic changes, proteinuria progressed even after stopping VGEF-I (Table).


In this review of patients treated with VEGF-I undergoing kidney biopsy, we described the histological characteristics, clinical course, and outcomes. Our review adds information to the sparse literature on patients with renal dysfunction after receiving VEGF-I.

PatientGenderAgeKidney Biopsy FindingsPrimary MalignancyCancer TreatmentOutcome
1F55PLA2R Negative Membranous Nephropathy, Minimal IgA NephropathyRenal Cell CarcinomaAxitinib + pembroluzimabN/A
2M59Cryoglobulinemia Type IIRenal Cell CarcinomaPazopanibProgression of Cancer
3M72IgA Nephropathy Diffuse DM glomerulosclerosisHepatocellular CarcinomaAtezolizumab + BevacizumabProgression of Cancer
4F51Acute to subacute TMAOvarian CancerBemcitabine + bevacizumabDeceased
5F63Subacute TMAColon CancerBevacizumabDisease progression, deceased
6F65TMAGlioblastoma MultiformeBevacizumabProgression of Cancer
7F67TMAEndometrial cancerBevacizumabProgression of Cancer, Decreased
8M62Subacute TMAGastrointestinal stromal tumorImatinib, Noilotinib, Regorafenib, Sunitinib, Pazopanib, Imatinib + DasatinibProgression of Cancer
9F58TMAOvarian CancerBevacizumabProgression of Cancer
10M60TMARenal Cell CarcinomaNivolumab + Ipilimumab, + CabozantinibN/A
11M68TMARenal Cell CarcinomaAxitinb + PembrolizumabProgression of Cancer