Renal involvement can range from asymptomatic proteinuria
to nephrotic syndrome and end-stage renal disease.
(<3.5 g/24 hrs) is much less specific and may occur with a wide range of renal and urinary tract conditions that must be excluded by clinical evaluation and investigation.
Clinically, renal adverse effects following anti-VEGF therapies may present as hypertension, asymptomatic proteinuria, and, rarely, nephrotic syndrome or acute renal failure.
In rare cases, patients with asymptomatic proteinuria can progress to nephrotic syndrome (<0.5% of patients) .
It is manifested by polyuria, microscopic hematuria, asymptomatic proteinuria
or renal stone in childhood.
Indications for biopsy included nephrotic syndrome (proteinuria with 3.5g/24 hours or greater with decreased serum albumin less than 3g/dL and edema), asymptomatic proteinuria
(protein excretion of greater than 0.15 g/24 hours), hematuria, or proteinuria and hematuria.
Clinically, nearly 60% of patients with class II lesions present with asymptomatic proteinuria (subnephrotic range), asymptomatic hematuria, or both with normal renal function (Table 1).
Frequency of Clinical Renal Manifestations in Various Classes of Lupus Glomerulonephritis (LGN): 541 Patients * ISN/RPS Class, % II III I (n = 54) (n = 107) Clinical Features (n = 5) ([dagger]) ([double dagger]) Asymptomatic hematuria 40 19 22 Asymptomatic proteinuria 40 42 25 Nephrotic syndrome 20 15 17 ([paragraph]) Nephritic syndrome # ...
-- Rule out transient or benign orthostatic cases of asymptomatic proteinuria
in children and adolescents before considering whether to refer them to a nephrologist.
GI perforation and wound dehiscence were rare side effects in trials; more common side effects include hypertension, nosebleeds, and asymptomatic proteinuria
Of the expected safety events identified in phase II studies, including bleeding, thromboembolism, asymptomatic proteinuria
, and hypertension, only grade 3 hypertension--easily managed with oral medication--was clearly increased, occurring in 10.9% of the IFL/bevacizumab patients and in 2.3% of the IFL/placebo patients.
Moreover, studies from the United States and Finland suggest that the positive predictive value of asymptomatic proteinuria
captured on a routine visit is less than 1%.