Worsening proteinuria and renal function after intravitreal vascular endothelial growth factor blockade for diabetic proliferative retinopathy.
Worsening proteinuria and renal function after intravitreal vascular endothelial growth factor blockade for diabetic proliferative retinopathy.
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DOI：
10.1093/ckj/sfaa049
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发表时间：
2020-12
影响因子：
4.6
通讯作者：
Kurtz I
中科院分区：
文献类型：
--
作者：
Shye M;Hanna RM;Patel SS;Tram-Tran N;Hou J;Mccannel C;Khalid M;Hanna M;Abdelnour L;Kurtz I
全身性血管内皮生长因子(VEGF)抑制可导致高血压、蛋白尿和各种肾小球疾病的恶化。这些药物还可用于治疗增殖性糖尿病视网膜病变、糖尿病黄斑水肿、视网膜中央静脉阻塞和老年性黄斑变性等眼科疾病。最近，药代动力学研究证实，这些药物的吸收水平导致血管内皮生长因子水平的生物学显著抑制。现在已经发表了23个其他病例，描述了玻璃体内阻断血管内皮生长因子的肾脏后遗症，不出所料，它们反映了已知的血管内皮生长因子抑制剂的全身毒性。我们提出了三个病例，在开始使用这些药物后，稳定的蛋白尿水平和慢性肾脏疾病恶化。我们三个病人中有两个做了活组织检查。第一例患者的活检显示糖尿病肾病和局灶节段性肾小球硬化(FSGS)并伴有塌陷特征和急性间质性肾炎(AIN)。第二例患者的活检显示AIN有糖尿病肾小球硬化的背景。这是我们组看到的第二例患者，其活检显示节段性肾小球硬化并伴有玻璃体内血管内皮生长因子阻断的塌陷特征。尽管具有塌陷特征的FSGS和AIN不是全身血管内皮细胞生长因子阻断的典型病变，但它们以前曾被报道为罕见病例。除了回顾玻璃体内血管内皮生长因子毒性的已知因素外，提交的病例还包括肾脏病理数据，支持玻璃体内阻断血管内皮生长因子可导致有害的全身和肾脏病理障碍。
Systemic vascular endothelial growth factor (VEGF) inhibitions can induce worsening hypertension, proteinuria and glomerular diseases of various types. These agents can also be used to treat ophthalmic diseases like proliferative diabetic retinopathy, diabetic macular edema, central retinal vein occlusion and age-related macular degeneration. Recently, pharmacokinetic studies confirmed that these agents are absorbed at levels that result in biologically significant suppression of intravascular VEGF levels. There have now been 23 other cases published that describe renal sequela of intravitreal VEGF blockade, and they unsurprisingly mirror known systemic toxicities of VEGF inhibitors. We present three cases where stable levels of proteinuria and chronic kidney disease worsened after initiation of these agents. Two of our three patients were biopsied. The first patient’s biopsy showed diabetic nephropathy and focal and segmental glomerulosclerosis (FSGS) with collapsing features and acute interstitial nephritis (AIN). The second patient’s biopsy showed AIN in a background of diabetic glomerulosclerosis. This is the second patient seen by our group, whose biopsy revealed segmental glomerulosclerosis with collapsing features in the setting of intravitreal VEGF blockade. Though FSGS with collapsing features and AIN are not the typical lesions seen with systemic VEGF blockade, they have been reported as rare case reports previously. In addition to reviewing known elements of intravitreal VEGF toxicity, the cases presented encompass renal pathology data supporting that intravitreal VEGF blockade can result in deleterious systemic and renal pathological disorders.
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影响因子：
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