Intravitreal Anti Vascular Endothelial Growth Factor-Driven Deterioration in Proteinuria, Renal Function, and Hypertension in the Context of Diabetic Nephropathy: A Case Report

Abstract

Diabetic retinopathy and nephropathy are microvascular complications of diabetes mellitus that often occur concomitantly. Anti vascular endothelial growth factor (VEGF) therapy is the mainstay of treatment for proliferative diabetic retinopathy and although oral and intravenous anti-VEGF therapies have been linked with adverse renal outcomes and hypertension, such associations with intravitreal anti-VEGF agents are less well established. Case Description: A case is presented of worsening hypertension, proteinuria, and renal function of a 62-year-old patient with presumed diabetic nephropathy who was referred to renal services with declining proteinuria and edema after being commenced on intravitreal anti-VEGF. Discussion: Intravitreal antiVEGF agents have a significant amount of systemic absorption and cases of worsening proteinuria, hypertension, and estimated glomerular filtration rate have been previously reported. There is a significant clinical overlap with the natural history of diabetic nephropathy and the epidemiology of this association is poorly understood. It is not clear what modifiable factors exist to minimize the development of this syndrome of worsening proteinuria, hypertension, and renal function. Conclusion: A heightened awareness of the potential for intravitreal anti-VEGF agents to lead to worsening proteinuria, hypertension, and renal function is required. Further study is needed to understand the potential modifiable factors to mitigate the adverse effects of these agents that have a key role in treating diabetic retinopathy.