Document Type

Article

Department

Internal Medicine (East Africa); Haematology and Oncology, East Africa

Abstract

Introduction Anti-angiogenic therapies, including vascular endothelial growth factor (VEGF) inhibitors and tyrosine kinase inhibitors (TKIs), have transformed cancer management by targeting tumor vasculature and suppressing metastasis. However, these agents can induce renal toxicities such as hypertension, proteinuria, and acute kidney injury (AKI), which may affect treatment continuity and outcomes. Data from sub-Saharan Africa on these adverse effects remains scarce.

Methods This was a retrospective cross-sectional study conducted at the Aga Khan University Hospital, Nairobi, oncology clinic. Medical records of adult patients receiving anti-angiogenic therapy between January 2020 and December 2024 were reviewed. Demographic data, comorbidities, treatment regimens, renal parameters, and renal adverse effects were analyzed. AKI was defined by KDIGO criteria, while proteinuria and hypertension were recorded from clinical and laboratory documentation.

Results Eighty-eight patients were included. Nine patients (10.2%) developed proteinuria: eight were on bevacizumab and one on lenvatinib. Among those on bevacizumab, one had resolution with angiotensin receptor blocker and steroids, three had therapy held, and in four, the proteinuria resolved spontaneously. Five patients (5.7%) developed AKI—three on bevacizumab and two on lenvatinib. Both patients on lenvatinib experienced nausea, vomiting, and AKI; one required renal replacement therapy. Ten patients (11.4%) developed new-onset hypertension: six on bevacizumab and four on lenvatinib. Of those on bevacizumab, four were managed with antihypertensive therapy, one had treatment held, and one had therapy interrupted. Among lenvatinib recipients, two had dose reductions and two had treatment held completely. Overall, the prevalence of new-onset AKI was 4.5%.

Conclusion Renal adverse effects related to anti-angiogenic therapy were observed in approximately 10% of patients, with bevacizumab predominantly associated with proteinuria and hypertension, and lenvatinib with AKI and hypertension. Most events were manageable through dose modification or supportive therapy. These findings highlight the importance of close renal monitoring, early recognition of toxicity, and individualised management to maintain oncologic efficacy while preserving renal function. Larger multi-center studies are needed to confirm these findings in the African oncology populations.

Publication (Name of Journal)

Kidney International Reports

DOI

https://doi.org/10.1016/j.ekir.2026.104022

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