Crescentic glomerulonephritis associated with vascular endothelial growth factor (VEGF) inhibitor and bisphosphonate administration

Nephrol Dial Transplant. 2011 May;26(5):1742-5. doi: 10.1093/ndt/gfr093. Epub 2011 Mar 7.

Abstract

Bevacizumab, a vascular endothelial growth factor (VEGF) inhibitor, has been widely used in a variety of malignancies offering substantial clinical benefit. Hypertension and proteinuria are the most commonly reported manifestations of bevacizumab-related nephrotoxicity with the risk increasing along with the dose and with the concomitant use of bisphosphonates. We describe the first case of a patient with small-cell lung cancer who developed diffuse extracapillary necrotizing crescentic glomerulonephritis, temporarily necessitating haemodialysis, following administration of bevacizumab and zolendronate. Renal function improved without any specific treatment and the patient remained off dialysis after withdrawal of bevacizumab-zolendronate. Special caution is required when VEGF inhibitors are combined with bisphosphonates. Such a combination can cause crescentic necrotizing glomerular lesions. Withdrawal of the offending medications may be adequate for the alleviation of this severe glomerulonephritis.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Angiogenesis Inhibitors / adverse effects
  • Antibodies, Monoclonal / adverse effects*
  • Antibodies, Monoclonal, Humanized
  • Bevacizumab
  • Bone Density Conservation Agents / adverse effects
  • Diphosphonates / adverse effects*
  • Drug Therapy, Combination
  • Glomerulonephritis / diagnosis
  • Glomerulonephritis / etiology*
  • Glomerulonephritis / therapy
  • Humans
  • Imidazoles / adverse effects*
  • Lung Neoplasms / complications
  • Lung Neoplasms / drug therapy*
  • Male
  • Renal Dialysis
  • Small Cell Lung Carcinoma / complications
  • Small Cell Lung Carcinoma / drug therapy*
  • Treatment Outcome
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors*
  • Zoledronic Acid

Substances

  • Angiogenesis Inhibitors
  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Bone Density Conservation Agents
  • Diphosphonates
  • Imidazoles
  • VEGFA protein, human
  • Vascular Endothelial Growth Factor A
  • Bevacizumab
  • Zoledronic Acid