scholarly journals Atypical haemolytic uremic syndrome from multiple missenses to a full-blown disease

2019 ◽  
Vol 12 (6) ◽  
pp. e230026 ◽  
Author(s):  
Filipe Santos Mira ◽  
Ana Luísa Nunes ◽  
Ana Rita Elvas ◽  
Nuno Oliveira
Keyword(s):  
Kidney Injury ◽  
Age Related Macular Degeneration ◽  
Activity Levels ◽  
Haemolytic Uremic Syndrome ◽  
Age Related ◽  
Elevated Liver Enzymes ◽  
Factor Inhibitor ◽  
History Of ◽  
Uremic Syndrome ◽  
Endothelial Growth Factor

A 72-year-old woman was admitted to the hospital because of dorsal, lumbar and lower abdomen pain that had started 4 days before. She had a history of age-related macular degeneration (treated with intraocular bevacizumab). Blood tests showed anaemia, thrombocytopaenia, acute kidney injury, elevated liver enzymes and total bilirubin (mainly because of the indirect fraction). Viral serologies and ADAMTS13 activity levels were normal, and stool testing was negative for Escherichia coli-producing Shiga toxins. E. coli was isolated in urine. Atypical haemolytic uremic syndrome triggered by a urinary tract infection or by the vascular endothelial growth factor-inhibitor bevacizumab were the most likely hypothesis. The patient started urgent plasmapheresis and dialysis that lasted for a total of 18 days. There was complete remission and recovery of kidney function allowing for treatment discontinuation, and she was discharged home. After 6 months of follow-up, she shows no signs of relapse.

scholarly journals Effects of Smoking on Outcomes of Antivascular Endothelial Growth Factor Therapy in Patients with Neovascular Age-Related Macular Degeneration Smoking and Anti-VEGF Therapy in nAMD

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Hiroyuki Kamao ◽  
Katsutoshi Goto ◽  
Yumi Mito ◽  
Atsushi Miki ◽  
Junichi Kiryu
Keyword(s):  
Growth Factor ◽  
Age Related Macular Degeneration ◽  
Heavy Smoking ◽  
Age Related ◽  
Antivascular Endothelial Growth Factor ◽  
History Of ◽  
Never Smokers ◽  
Endothelial Growth Factor ◽  
Number Of Injections ◽  
Heavy Smokers

Purpose. To evaluate the effect of smoking on the outcome of antivascular endothelial growth factor (VEGF) therapy in patients with neovascular age-related macular degeneration (nAMD). Methods. This retrospective case-control study included 64 eyes in 59 patients with treatment-naïve nAMD. Smoking habits were obtained from hospital records and patient recall. The patients were divided into ever-smokers and never-smokers. The patients were treated with ranibizumab or aflibercept for at least 1 year. Outcome measures were best-corrected visual acuity (BCVA), central retinal thickness (CRT) at the fovea, subfoveal choroidal thickness (SCT), and number of injections received. Results. There were no statistically significant differences in BCVA, CRT, or SCT changes between ever-smokers and never-smokers. The number of injections received was significantly higher in ever-smokers with a history of heavy smokers (never-smokers vs. heavy smokers: 5.3 ± 2.6/year vs. 7.3 ± 2.5/year; P=0.048 and mild smokers vs. heavy smokers: 5.2 ± 2.5/year vs. 7.3 ± 2.5/year; P=0.043). There was no significant difference in the baseline CRT or presence of atrophic retinal pigment epithelium in the fellow eyes of patients with nAMD according to smoking status; however, the baseline CRT in eyes with nAMD was significantly thinner in ever-smokers than in never-smokers (P=0.02). Conclusion. The anti-VEGF therapy was frequently required in nAMD patients with a history of heavy smoking. Heavy smoking could cause poor therapeutic response in nAMD patients.

Bevacizumab-induced atypical hemolytic uremic syndrome and treatment with eculizumab

2018 ◽  
Vol 25 (4) ◽  
pp. 1011-1015 ◽  
Author(s):  
Anusha Vakiti ◽  
Daulath Singh ◽  
Ravi Pilla ◽  
Muhamad Alhaj-Moustafa ◽  
Kelly W Fitzpatrick
Keyword(s):  
Hemolytic Uremic Syndrome ◽  
Atypical Hemolytic Uremic Syndrome ◽  
Age Related Macular Degeneration ◽  
Age Related ◽  
Humanized Monoclonal Antibody ◽  
Increased Risk ◽  
Factor Inhibitor ◽  
Angiogenic Effect ◽  
Uremic Syndrome ◽  
Clinical Triad

Bevacizumab (Avastin) is a recombinant humanized monoclonal antibody used for the management of various solid malignancies including colorectal, lung, brain, renal, and ovarian cancers as well as age-related macular degeneration of the eye. It is a vascular endothelial growth factor inhibitor which exhibits its action by blocking the growth of blood vessels in cancerous tissue. Common side effects include hypertension, fatigue, headaches, and increased risk of infections. Atypical hemolytic uremic syndrome is a serious side effect associated with bevacizumab due to its anti-angiogenic effect. It encompasses the clinical triad of thrombocytopenia, microangiopathic hemolytic anemia, and acute renal failure, without any association with Shiga toxins. Eculizumab is a terminal complement inhibitor used in the treatment of atypical hemolytic uremic syndrome. Herein, we present three cases of bevacizumab-induced atypical hemolytic syndrome treated successfully with eculizumab.

scholarly journals Efficacy of Anti-Vascular Endothelial Growth Factor Treatment in Neovascular Age-Related Macular Degeneration and Systemic Cardiovascular Risk Factors

2021 ◽  
Vol 10 (19) ◽  
pp. 4595
Author(s):  
Joanna Łądkowska ◽  
Maciej Gawęcki ◽  
Marek Szołkiewicz
Keyword(s):  
Risk Factors ◽  
Visual Acuity ◽  
Arterial Hypertension ◽  
Density Lipoprotein ◽  
Age Related Macular Degeneration ◽  
Vascular Endothelial ◽  
Corrected Visual Acuity ◽  
Age Related ◽  
History Of ◽  
Endothelial Growth Factor

This study evaluates whether the presence of cardiovascular risk factors (CRFs) affects functional and morphological responses to anti–vascular endothelial growth factor (VEGF) therapy in patients with neovascular age-related macular degeneration (nAMD). Retrospective analysis included 98 treatment-naïve eyes followed for at least 12 months. Patients received intravitreal injections of ranibizumab or aflibercept with the dosage and regimen set according to each manufacturer’s recommendations for their product. Parameters evaluated at each follow-up visit included best-corrected visual acuity and central retinal thickness. Additionally, the presence of the following CRFs was evaluated: male sex, age of older than 70 years, history of current or past smoking, systemic arterial hypertension, diabetes mellitus, total hypercholesterolemia, low-density lipoprotein hypercholesterolemia, high-density lipoprotein concentration of 45 mg/dL or less, atherogenic dyslipidemia, family history of cardiovascular disease, and chronic kidney disease. A statistically significant better letter gain in visual acuity (p = 0.012) and greater percentage of responders (p = 0.035)—that is patients in whom best corrected visual acuity was stabilized or improved at 12 months—were noted among patients without a diagnosis of arterial hypertension. A statistically significant better mean visual improvement was also achieved in patients with higher total cholesterol plasma levels (p = 0.004), but this finding was not reflected in the significantly higher percentage of responders. The presence of remaining analyzed risk factors did not substantially affect the results of treatment. Systemic arterial hypertension is an independent factor leading to a poor functional outcome following anti-VEGF therapy in patients with nAMD. Effects of anti-VEGF treatment in patients with high total cholesterol levels should be analyzed in further research.

Sign in / Sign up

Export Citation Format

Share Document