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논문분류	춘계학술대회 초록집
제목	A Case of Repeated Renal Bleeding After Kidney Biopsy During Atezolizumab and Bevacizumab Treatment for Hepatocellular Carcinoma
저자	Ju Hwan Oh
출판정보	2025; 2025(1):
키워드	kidney biopsy , bevacizumab, transarterial embolization
초록	A 65-year-old man admitted to undergo kidney biopsy for the evaluation of proteinuria. He had a history of chronic B hepatitis, and no history of hypertension and diabetes. On admission, his blood pressure was 130/80 mmHg, and body temperature was 36.8 ºC. His hemoglobin concentration was 10.5 g/dL. The blood urea nitrogen and serum creatinine concentrations were 13 mg/dL and 0.98 mg. The patient’s urinary protein excretion was 2.25 g/day on admission. Serological tests revealed the presence of anti-nuclear antibodies and anti-double stranded antibodies. Kidney biopsy was performed on day 2. After kidney biopsy, he experienced flank pain and gross hematuria on day 3. The computed tomography showed the large amount of hematoma in perirenal space (Fig. 1). Therefore, the radiologist performed trans-arterial embolization (TAE) using gel foam for the treatment of renal hemorrhage. There was no recurrence of gross hematuria. He underwent magnetic resonance imaging for the evaluation of liver mass, which showed huge mass in the liver left lobe in right lobe suggestive of hepatocellular carcinoma (HCC). We initiated treatment with (Atezolizumab-bevacizumab #1) for HCC after 5 days of TAE. Three days after chemotherapy, he complained of recurrent hematuria and left flank pain. The hemoglobin decreased from 10.2 to 8.9 mg/dL. Thus, the patient received second TAE using gel foam. However, the patient complained flank pain 6 days later of 2nd TAE. Thus, the radiologist performed renal artery embolization using Glue, which is a liquid embolic agent (Fig. 2). The patient discharged 7 day later without renal bleeding. Bevacizumab therapy is associated with an increased risk of gastrointestinal hemorrhages. This case showed that bevacizumab therapy is also associated with increased the risk of bleeding after kidney biopsy. Therefore. it is needed to start bevacizumab therapy carefully for fear of bleeding, in case of kidney biopsy.
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