Lenvatinib-associated hyaline occlusive glomerular microangiopathy

Nephrologists play a key role in managing renal complications related to malignancy and its treatment. Although immunotherapies and oral small-molecule agents have revolutionized cancer care, severe adverse events may limit their use. We report a distinctive glomerular injury pattern associated with lenvatinib, an oral receptor tyrosine kinase inhibitor. Similar histopathologic features have been observed with bevacizumab and anti-vascular endothelial growth factor receptor 2 (VEGFR2) antibodies. This case includes extended clinical follow-up, kidney biopsy findings, and therapeutic modification, suggesting a possible association between VEGF–VEGFR2 pathway inhibition and reversible nephrotoxicity.