title: Proteinuria and hypertension in patients treated with inhibitors of the VEGF signalling pathway--incidence, mechanisms and management.
abstract: Anti-VEGF therapy dramatically improved the outcome of patients with renal cancer and other advanced malignancies, but may be complicated by proteinuria and hypertension. VEGF is indispensable for the normal development of glomerulus and preservation of glomerular filtration barrier. Interference with its action may result in damage to glomerular endothelial cells and (in severe cases) in renal thrombotic microangiopathy. Blood pressure and proteinuria (using dipstick) should be assessed in all patients before starting anti-VEGF therapy and regularly monitored during the treatment. Patients with severe proteinuria and/or impaired renal function should be referred to the nephrologist for further work-up. Hypertension caused by anti-VEGF therapy can be effectively treated; progression of proteinuria and/or renal dysfunction may require tapering, or even withdrawal of anti-VEGF treatment.
authors.affiliation: Department of Oncology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic. tesarova.petra@seznam.cz
authors.forename: P
authors.initials: P
authors.lastname: Tesařová
authors.forename: V
authors.initials: V
authors.lastname: Tesař
mesh_terms: D020533:Angiogenesis Inhibitors / Q000009:adverse effects* / Q000494:pharmacology; D006801:Humans; D006973:Hypertension / Q000139:chemically induced* / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D015994:Incidence; D011507:Proteinuria / Q000139:chemically induced* / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D015398:Signal Transduction / Q000187:drug effects*; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors* / Q000378:metabolism
chemical_list: D020533:Angiogenesis Inhibitors; D042461:Vascular Endothelial Growth Factor A