Hypertonie und renale thrombotische Mikroangiopathie unter anti-angiogener Tumortherapie

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• 作者：Prof. Dr. I. Grgic ; Prof. Dr. A. Burchert ; Prof. B. D. Humphreys MD ; PhD
• 关键词：Anti ; angiogene Therapie ; VEGF ; Signalgebung ; Arterielle Hypertonie ; Proteinurie ; Renale thrombotische Mikroangiopathie ; Anti ; angiogenic therapy ; VEGF signaling pathway ; Arterial hypertension ; Proteinuria ; Renal thrombotic microangiopathy
• 刊名：Der Nephrologe
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：11
• 期：1
• 页码：20-27
• 全文大小：570 KB
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• 作者单位：Prof. Dr. I. Grgic (1)
  Prof. Dr. A. Burchert (2)
  Prof. B. D. Humphreys MD, PhD (3) (4) (5)
  
  1. Klinik für Innere Medizin und Nephrologie, Universitätsklinikum Gießen und Marburg, Philipps-Universität Marburg, Baldingerstraße 1, 35033, Marburg, Deutschland
  2. Klinik für Hämatologie, Onkologie und Immunologie, Universitätsklinikum Gießen und Marburg, Philipps-Universität Marburg, 35033, Marburg, Deutschland
  3. Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
  4. Dana Farber Cancer Institute, Lance Armstrong Foundation, Boston, Massachusetts, USA
  5. Department of Medicine, Washington University Medical Center, St Louis, Missouri, USA
  
• 刊物主题：Nephrology; Angiology; Metabolic Diseases; Oncology; Transplant Surgery; Urology/Andrology;
• 出版者：Springer Berlin Heidelberg
• ISSN：1862-0418

文摘

Anti-angiogenic therapies (AAT) targeting the VEGF signaling pathway (VSP) are increasingly used by oncologists for palliative treatment of patients with various solid tumors. While these non-curative drugs may improve certain treatment endpoints in selected cancer entities, clinical data suggest that they also cause a number of serious cardiovascular and renal side effects at rather high rates. For instance, the incidence of clinical hypertension has been estimated to be 19-24% and may be even higher with more potent second-generation VSP inhibitors. Onset of proteinuria has been observed in up to 20% of treated cases. Another frequently occurring renal complication under AAT is the development of renal thrombotic microangiopathy (TMA). This pattern of injury is the same as found in patients with pre-eclampsia, also a disease of disordered VEGF signaling and endothelial dysfunction. Because use of these medications continues to grow and many new formulations in development, there is an increasing need for the nephrologist to learn how to diagnose and manage VSP inhibitor toxicities. But at the same time there is a great opportunity to try connect these adverse events and clinical phenotypes back to the molecular mechanisms precipitating them. Consistent with the concept of personalized medicine, we may at some point use this new knowledge to individualize and hence optimize therapies for patients undergoing anti-angiogenic treatment. Keywords Anti-angiogenic therapy VEGF signaling pathway Arterial hypertension Proteinuria Renal thrombotic microangiopathy