Nephrotic Syndrome After Bevacizumab: Case Report and Literature Review

Bevacizumab, or avastin, is a monoclonal hybrid antibody that binds to and neutralizes vascular endothelial growth factor. It has shown promising efficacy in the adjunctive treatment of patients with several cancers. Recent reports indicated that bevacizumab therapy often was associated with the development of proteinuria, but rarely nephrotic syndrome. In this report, we describe a patient who developed new-onset hypertension and nephrotic syndrome in association with bevacizumab treatment for metastatic pancreatic cancer. Renal biopsy showed an immune-complex-mediated focal proliferative glomerulonephritis. Nephrotic syndrome and hypertension resolved after discontinuation of bevacizumab therapy. The mechanism of bevacizumab-induced glomerulonephritis and nephrotic syndrome is unknown and requires additional investigation. Clinicians should be aware of the potential reversible nephrotoxicity of bevacizumab and should monitor blood pressure and urine protein excretion closely during therapy with this agent.