A Case of Renal Bleeding After Kidney Biopsy During Bevacizumab Treatment

Introduction: The combination of atezolizumab and bevacizumab was approved as a first-line systemic therapy for advanced hepatocellular carcinoma (HCC). Bevacizumab therapy increase gastrointestinal bleeding. However, there is no report showing the bleeding complication after kidney biopsy after bevacizumab therapy. Case Description: A 65-year-old Korean man was admitted to our hospital for a renal biopsy to evaluate proteinuria. He had a history of chronic hepatitis B without medication. The patient’s urinary protein excretion was 2.25 g/day. A kidney biopsy was performed on day 2, and the patient experienced flank pain and gross hematuria on day 3. The abdominal computed tomography (CT) scan showed the large amount of hematoma in the perirenal space and pseudoaneurysm in the lower pole of the left kidney (Fig. 1). Therefore, the intervention radiologist performed transcatheter renal artery embolization (TAE) using gel foam and microcoils (Fig. 2A, 2B). Infiltrative HCC was incidentally detected on abdominal CT. The patient was transferred to the hepatology department and received systemic chemotherapy (atezolizumab-bevacizumab) 5 days after TAE. Three days after chemotherapy, the patient complained of gross hematuria, and hemoglobin level decreased from 10.2 to 8.9 mg/dL. Therefore, the patient underwent a second renal TAE using gel foam. However, the patient complained of flank pain six days after the 2nd TAE. The interventional radiologist performed 3rd renal TAE using glue (Fig. 2C), which is a liquid embolic agent. The patient was discharged 7 days later without renal bleeding. Discussion: This case suggests that bevacizumab may increase the risk of bleeding after renal biopsy and underscores the need for cautious use.