The use of vascular endothelial growth factor (VEGF) inhibitors, particularly anti-VEGF agents like Bevacizumab, has become a cornerstone in the treatment of proliferative diabetic retinopathy and diabetic macular edema. While systemic renal side effects of these agents are well-documented, emerging evidence suggests that intravitreal administration may also be associated with significant renal risks. We report the case of a 32-year-old male with a 25-year history of type 1 diabetes who developed thrombotic microangiopathy (TMA) following intravitreal Bevacizumab injections. Diagnostic evaluations ruled out other causes, leading to a diagnosis of drug-induced TMA. Treatment included corticosteroids and plasma exchange, but renal function did not recover, necessitating hemodialysis. This case underscores the critical need for renal monitoring in patients receiving anti-VEGF therapy, particularly those with preexisting renal impairment, to mitigate the risk of serious renal complications.
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