AUTHOR=Jian Xingxing , Liu Ge , Yu Shuangyan , Sheng Jie 

TITLE=Case Report: Bevacizumab-induced renal-limited TMA and FSGS-like lesions in a kidney transplant recipient

JOURNAL=Frontiers in Oncology

VOLUME=Volume 15 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2025.1638274

DOI=10.3389/fonc.2025.1638274

ISSN=2234-943X

ABSTRACT=Bevacizumab, an anti-VEGF agent commonly employed in cancer therapy, can induce renal vascular endothelial and podocyte damage by inhibiting VEGF, leading to renal disease. We present a case of nephrotic syndrome and renal insufficiency arising from small intestinal mucinous adenocarcinoma 17 years post-renal transplantation, treated with bevacizumab and sindilizumab. Renal biopsy confirmed renal-limited thrombotic microangiopathy (TMA) with FSGS-like lesions in the transplanted kidney, attributed to bevacizumab. Upon discontinuation of the antitumor drugs and initiation of treatment with telmisartan, fenoldopam, and ambrisentan, proteinuria markedly decreased and eGFR improved. No tumor recurrence was observed over a follow-up period exceeding six months.