Interstitial nephritis secondary to bevacizumab treatment in metastatic leiomyosarcoma

Objective: To report a case of interstitial nephritis associated with the administration of bevacizumab. Case Summary: A 26-year-old man diagnosed with metastatic rectal leiomyosarcoma was treated with intravenous bevacizumab 5 mg/kg and received a total of 3 doses at 2 week intervals. His creatinine has increased from 1.0 mg/dL at baseline to 1.6 mg/dL after 2 doses of bevacizumab an to 4.7 mg/dL after the third dose, prompting admission. Acute renal failure was diagnosed, and hemodialysis was initiated. A renal biopsy revealed intersitial nephritis. Renal failure resolved with cessation of the drug, and the patient did not require further hemodialysis. Discussion: Bevacizumab is a recombinant humanized monoclonal immunoglobulin G antibody to vascular endothelial growth factor. Bevacizumab has shown efficacy in treatment with renal cell carcinoma and colorectal cancer and has been approved by the Food and Drug Administration as a first-line treatment for metastatic colorectal cancer. Our patient had no other confounding factors that might have caused renal failure. The presence of primary glomerular disease was excluded by biopsy. According to the Naranjo probability scale, bevacizumab was the probable cause of acute renal failure in this patient. Conclusions: Bevacizumab can cause acute renal failure by inducing interstitial nephritis. Renal function should be monitored during bevacizumab therapy.