Aflibercept-induced Nephrotic Syndrome
TH So, VHF Lee, KO Lam
Hong Kong J Radiol 2017;20:146-8
DOI: 10.12809/hkjr1716809
Aflibercept is a high-affinity ligand trap for vascular endothelial growth factor (VEGF) and is used as secondline therapy against metastatic colorectal cancer. It has a similar but potentially less favourable toxicity profile compared with other anti-angiogenic agents. We report a Chinese woman with metastatic colorectal cancer who developed nephrotic syndrome after a single dose of aflibercept (4 mg/kg) with FOLFIRI (leucovorin, fluorouracil, and irinotecan). On days 11 and 18, 24-hour urine collection showed urine protein of 6.07 and 8.72 g/day, respectively. Renal biopsy revealed chronic interstitial nephritis due to underlying obstructive uropathy. The nephrotic syndrome resolved after stopping aflibercept. This illustrates the reversible nature of aflibercept-induced proteinuria, especially when detected and treated early. It is important to monitor the urine protein level in patients prescribed aflibercept, even in those who tolerate other anti-VEGF therapies without significant proteinuria.
Authors’ affiliation:
TH So, VHF Lee, KO Lam: Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
中文摘要
阿普西柏誘發的腎病綜合症
蘇子謙、李浩勳、林嘉安
阿普西柏是血管內皮生長因子（VEGF）的配體陷阱，並用作二線治療轉移性結腸直腸癌。與其他抗血管生長藥相比，它具有相似但可能更不利的毒性。本文報導一名患轉移性結腸直腸癌的華籍女性，在接受單劑量的阿普西柏（4 mg / kg）及FOLFIRI (leucovorin, fluorouracil, and irinotecan) 後出現腎病綜合症。在第11天和第18天，24小時尿液收集顯示尿蛋白分別為每天6.07和8.72 g。腎活檢顯示阻塞性尿道症引致慢性間質性腎炎。腎病綜合症在停藥後緩解。這說明了此症的可逆性，檢測和治療及時尤為明顯。定期監測尿蛋白水平很重要，包括曾接受其他抗VEGF療法且沒有蛋白尿的患者。