Saturday, April 18, 2015

Tyrosine Kinase Inhibitors vs Anti VEGF therapy: What does the podocyte see?

Anti VEGF therapy has been known to cause proteinuric renal disease. A recent study published in Medicine has the largest single center series looking at biopsy proven findings of Anti VEGF and tyrosine kinase inhibitor therapies.

Some interesting points:

Most patients were biopsied for proteinuria
TMA was the most common biopsy finding if the drug used was an anti VEGF or TRAP agent, 50% of which were only renal limited.
Minimal Change disease/FSGS was the most common finding associated with tyrosine kinase inhibitors along with interstitial or tubular disease.  

This is an interesting observation that was not reported before. It appears that the VEGF inhibitors are strictly likely to behave like pre eclampsia like syndromes but the TKIs are more likely to cause a pure nephrotic syndrome like GN.  None had gotten steroids. It might be interesting to see if these drug induced MCD respond to steroids and hence we can then continue the agent for good cancer treatment.

Hypertension and proteinuria resolved following drug discontinuation and antihypertensive agents.
No patient developed severe renal failure requiring dialysis. 

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