抗血管内皮生长因子类药物致蛋白尿2例及文献复习

Proteinuria induced by anti-vascular endothelial growth factors:two cases report and literature review

该文报道2例肝癌和卵巢癌患者在使用抗血管内皮生长因子(vascular endothelial growth factor,VEGF)类药物治疗过程中出现蛋白尿的病例。一例肝癌患者在使用特瑞普利单抗/卡瑞利珠单抗联合仑伐替尼、瑞戈非尼等抗VEGF类药物过程中出现高血压、大量蛋白尿、肾功能不全,24 h尿蛋白量为4.02 g。另1例卵巢癌患者在使用贝伐珠单抗过程中出现高血压、蛋白尿,24 h尿蛋白量为1.13 g。两例患者肾活检均提示肾小球呈血栓性微血管病样改变,考虑抗VEGF类药物相关性肾小球微血管病。肝癌患者在仑伐替尼药物剂量减半后病情无缓解,使用小剂量糖皮质激素联合肾素-血管紧张素-醛固酮系统抑制剂治疗后效果不佳。两例患者均在停用抗VEGF类药物后尿蛋白转阴。

This article reports two cases of proteinuria caused by anti-vascular endothelial growth factor(VEGF)drugs in the treatment of liver cancer and ovarian cancer,respectively.Hypertension,massive albuminuria and renal insufficiency occurred in the patient with liver cancer during the use of toripalimab/camrelizumab combined with lenvatinib and regorafenib,and urinary protein was 4.02 g/24 h.The patient with ovarian cancer developed hypertension,proteinuria and 1.13 g/24 h urinary protein during the use of bevacizumab.Renal biopsy showed thrombotic microangiopathy in the glomeruli of both patients.Anti-VEGF drugs-associated glomerular microangiopathy was considered.The patient with liver cancer had no improvement after halving the dose of lenvatinib,and the effect was not good after treatment with low-dose corticosteroids combined with renin-angiotensin-aldosterone system inhibitors.After stopping anti-VEGF drugs,the proteinuria in both patients turned negative.