What is the relationship between Bevacizumab (Bevacizumab is a brand name, the generic name is not needed as it is the same) and impaired renal function?

From the Guidelines

Bevacizumab can cause renal failure through several mechanisms, primarily through thrombotic microangiopathy, proteinuria, and hypertension, and patients receiving bevacizumab should have regular monitoring of kidney function, blood pressure, and urinalysis for proteinuria. The use of bevacizumab has been associated with hypertension, thromboembolism, and cardiomyopathy 1. Approximately 2%–4% of patients treated with bevacizumab will develop heart failure, and predisposing factors include previous therapy with cardiotoxic chemotherapy drugs, such as anthracyclines, capecitabine, as well as radiation to the mediastinum 1. Some key points to consider when using bevacizumab include:

• Regular monitoring of kidney function, blood pressure, and urinalysis for proteinuria
• Temporary suspension of bevacizumab if a patient develops significant proteinuria (>2g/24h) until proteinuria improves to <2g/24h
• Permanent discontinuation for severe proteinuria (>3.5g/24h) or renal impairment (creatinine >1.5 times baseline)
• Blood pressure control before starting bevacizumab, with a target of <140/90 mmHg, and monitored every 2-3 weeks during initial treatment
• Aggressive management of hypertension with antihypertensive medications, preferably ACE inhibitors or ARBs Bevacizumab works by inhibiting vascular endothelial growth factor (VEGF), which is essential for maintaining the glomerular filtration barrier, and when VEGF is inhibited, podocyte function is disrupted, leading to proteinuria and potential renal damage 1. The risk of renal failure is higher in patients with pre-existing kidney disease, hypertension, or those receiving other nephrotoxic medications, and aggressive blood pressure control and regular monitoring of kidney function are crucial to minimize the risk of renal failure in patients receiving bevacizumab.

From the FDA Drug Label

Renal Injury and Proteinuria: bevacizumab products increase the risk of proteinuria and renal injury, including nephrotic syndrome. Bevacizumab may cause renal failure due to increased risk of proteinuria and renal injury, including nephrotic syndrome.

• Patients should be monitored for renal function and proteinuria.
• Patients should contact their healthcare provider for signs and symptoms of nephrotic syndrome 2

From the Research

Bevacizumab and Renal Failure

Bevacizumab, a medication used to treat various types of cancer, has been associated with renal failure and proteinuria in some patients. The following points summarize the key findings related to bevacizumab and renal failure:

• Incidence of Proteinuria: The incidence of any-grade proteinuria was 8.2% in patients treated with bevacizumab, compared to 4.6% in the control group 3.
• Risk Factors: History of diabetes was found to be a significant risk factor for the development of proteinuria in patients treated with bevacizumab 3.
• Clinical Manifestations: The most common clinical manifestation of bevacizumab-induced renal injury was proteinuria (>3.5 g/d), followed by microscopic hematuria, malignant hypertension, elevated serum creatinine level, and anuria 4.
• Pathological Types: Thrombotic microangiopathy was the main pathological type associated with bevacizumab-induced renal injury, followed by membranoproliferative glomerulonephritis and benign arteriolar nephrosclerosis 4.
• Monitoring and Management: Regular monitoring of urine protein excretion and renal function is recommended during bevacizumab treatment to identify any renal injury 4, 5.
• Treatment Modifications: Treatment modifications, such as delaying therapy, may be necessary in patients who develop grade 2+ proteinuria 5.
• Diagnostic Tools: The urine protein to creatinine ratio (UPCR) has been found to be a useful diagnostic tool for assessing bevacizumab-associated proteinuria, with a sensitivity of 0.71 and specificity of 0.88 6.

Key Findings

The key findings related to bevacizumab and renal failure can be summarized as follows:

• Bevacizumab is associated with an increased risk of proteinuria and renal failure.
• Regular monitoring of urine protein excretion and renal function is necessary during bevacizumab treatment.
• Treatment modifications may be necessary in patients who develop grade 2+ proteinuria.
• The UPCR is a useful diagnostic tool for assessing bevacizumab-associated proteinuria.

Proteinuria Monitoring

Proteinuria monitoring is an essential aspect of bevacizumab treatment, as it can help identify renal injury early on. The following points summarize the key findings related to proteinuria monitoring:

• Frequency of Monitoring: The frequency of proteinuria monitoring varies, with some studies suggesting that monitoring may not be necessary for short definitive courses of bevacizumab 5.
• Diagnostic Tools: The UPCR has been found to be a useful diagnostic tool for assessing bevacizumab-associated proteinuria, with a sensitivity of 0.71 and specificity of 0.88 6.
• Cost-Effectiveness: The UPCR has been found to be a cost-effective diagnostic tool, saving one unnecessary 24-h urine test for less than a dollar compared to a simple urine dipstick 6.