Renal-Limited Thrombotic Microangiopathy due to Anti-VEGF/TKI Immunotherapy for Metastatic Renal Cell Carcinoma Presenting as Nephrotic Syndrome: A Case Report and Literature Review.

Vascular endothelial growth factor (VEGF) inhibition may result in proteinuria, worsening hypertension, chronic kidney injury, or glomerular disease. Recently, systemic VEGF inhibition has been reported to cause nephrotic disorders and thrombotic microangiopathy (TMA). We present a unique case of renal-limited TMA presenting as nephrotic syndrome in a patient on anti-VEGF/TKI immunotherapy and immune checkpoint inhibitors for metastatic renal cell carcinoma.