Intravitreal vascular endothelial growth factor inhibitor systemic and renal toxicity registry.

Background: Intravitreal vascular endothelial growth factor inhibitors (IVEGFi) are used in the treatment of diabetic retinopathy, age-related macular degeneration (AMD) and central retinal vein obstruction. As we have previously reported, there are an increasing number of cases documenting IVEGFi with renal injury and increased concentrations in the serum. To assess this claim, we have developed a novel reporting system through an electronic registry for cases of suspected VEGFi injury.

Methods: A website with multiple data protection sets was created to educate, promote awareness and capture patient cases of suspected IVEGFi toxicity. The website displays the molecular biology of VEGF signaling, the process of absorption into the bloodstream, and study reports showing risks on case, cohort and epidemiologic levels. A Health Insurance Portability and Accountability Act (HIPAA)-compliant patient intake form was designed to collect renal, cardiovascular, cerebrovascular, renal biopsy and function data along with drug type, indication and frequency of administration.

Results: In our updated cohort we added 16 total cases from the literature showing signs of renal injury from the patient population receiving VEGFi. In current literature, 46 cases of VEGFi-related renal injury have been documented. To them, we add our 16 cases for a total of 62 cases.

Conclusion: The current database for VEGFi-related nephrotoxicity constitutes the largest case series presented for this condition. This study opens the door for future studies to evaluate what subgroups experience acute kidney injury, proteinuria and hypertension exacerbations. Additionally, we may expand on our database to include timeline markers for symptomatic-correlative VEGFi usage and, in time, predictive measures on a larger scale to correlate comorbidity/drug use with drug effect and mechanism of action.