Early marker of proteinuria in patients treated with an Anti-vegf treatment
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A Case of Podocyturia in a Patient Receiving Anti-VEGF Therapy with Sunitinib
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[0034]A 67 year old female presented with a 7.2×6.1 cm mass involving the central and lower portion of the right kidney. Renal function was normal with a creatinine of 1.0 and no proteinuria. She subsequently underwent a right radical nephrectomy and retroperitoneal lymphadenectomy. Pathology confirmed Grade 2, T2, N0, M1 renal cell carcinoma, clear cell type. Sunitinib therapy was initiated, with good response.
[0035]Four months into therapy, renal function worsened with a peak creatinine of 1.5 and 467 mg of protein in 24 hours. Angiotensin receptor blockade with Diovan was initiated. Additional side effects included hypertension, hand and foot syndrome, and drug-induced hypothyroidism.
[0036]After seven months of therapy, her creatinine improved to 1.3 but she remained proteinuric, with a predicted 24 hour protein of 931 mg. At that time, a podocyturia assay was performed as described below and the presence of urinary podocytes was confirmed (FIG. 1).
Detection of Podocytes
[0037]A ...
example 2
Podocyturia in Patients Treated with VEGF Blocking Therapy for Cancer
[0041]The following was performed to determine whether podocyturia is present in patients who, while undergoing anti-VEGF therapy, develop proteinuria (Table 1). In addition, urinary podocyte excretion was compared among patients on anti-VEGF therapy with proteinuria ranging from 101 to 9720 mg / d (Table 1).
Table 1Anti-Type of CancerAge / SexVEGFGFRProteinuriaCells / HPFCholangio68 / FB66420 mg / d0Renal Cell60 / MS / nib39101 mg / d1Colorectal55 / FB1371 + dipstick1Colon66 / FB + S / nib77330 mg / d0GBM59 / FB + S / nib78152 mg / d1Renal Cell73 / MB632144 mg / d>3Renal Cell67 / FSunitib432112 mg / d>3SBC68 / MB596361 mg / d>3GBM70 / MS / nib709720 mg / d>9GBM: glioblastoma multiforme; SBC: small bowel carcinoid; B: bevacizumab; S / nib:sorafenib; HPF: 400x high power field.
[0042]These results demonstrate a higher degree of podocyturia in patients undergoing anti-VEGF therapy with proteinuria in excess of 2 gr / d compared to those treated with the same agents and...
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