Abstract
We present a case of a 76 year old female with biopsy proven thrombotic microangiopathy secondary to Bevacizumab, who was treated with Eculizumab. She had a history of hepatocellular carcinoma that was treated with Atezolizumab and Bevacizumab. She presented to the hospital for peripheral edema and confusion with workup significant for acute kidney injury and proteinuria. Renal biopsy revealed findings consistent with thrombotic microangiopathy. Her renal function continued to worsen eventually requiring hemodialysis.
Bevacizumab is a vascular endothelial growth factor (VEGF) targeting monoclonal antibody that is associated with hypertension, proteinuria, and renal thrombotic microangiopathy (TMA). Pathophysiology of injury includes direct endothelial cell injury and initial treatment is drug discontinuation. Our patient presented with worsening acute kidney injury (AKI) despite receiving her last dose of Bevacizumab 1 month prior. For this reason, therapy with Eculizumab was started and she received a total of four doses with outcome of improved urine output and stabilization of serum creatinine off of dialysis. This case suggests further therapeutic role of Eculizumab for Bevacizumab associated TMA.
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