Anti-vascular endothelial growth factor (VEGF) drugs inhibit tumor angiogenesis by blocking the VEGF-VEGF receptor signaling pathway and serve as a key therapeutic option for rat sarcoma viral oncogene homolog wild-type metastatic colorectal cancer. However, these drugs may induce kidney damage through mechanisms such as excessive activation of the local complement system, reduced production of prostaglandin E2 and abnormal endothelial cell-podocyte crosstalk. The diagnosis of kidney damage associated with anti-VEGF drugs is based on pathological findings, with thrombotic microangiopathy being a characteristic feature. Given that cancer patients are frequently treated with multiple potentially nephrotoxic drugs, a renal biopsy is recommended when proteinuria or other signs of kidney damage are detected. After confirmation, anti-VEGF drugs should be promptly discontinued, and individualized strategies based on proteinuria severity should be implemented. Since renal impairment may affect cancer therapy, early recognition and intervention are crucial. The current understanding of this disease in China remains limited. This article reviews its pathogenesis, pathological features, and treatment strategies, aiming to provide a reference basis for clinical practice.

Anti-vascular endothelial growth factor (VEGF) drugs inhibit tumor angiogenesis by blocking the VEGF-VEGF receptor signaling pathway and serve as a key therapeutic option for rat sarcoma viral oncogene homolog wild-type metastatic colorectal cancer. However, these drugs may induce kidney damage through mechanisms such as excessive activation of the local complement system, reduced production of prostaglandin E2 and abnormal endothelial cell-podocyte crosstalk. The diagnosis of kidney damage associated with anti-VEGF drugs is based on pathological findings, with thrombotic microangiopathy being a characteristic feature. Given that cancer patients are frequently treated with multiple potentially nephrotoxic drugs, a renal biopsy is recommended when proteinuria or other signs of kidney damage are detected. After confirmation, anti-VEGF drugs should be promptly discontinued, and individualized strategies based on proteinuria severity should be implemented. Since renal impairment may affect cancer therapy, early recognition and intervention are crucial. The current understanding of this disease in China remains limited. This article reviews its pathogenesis, pathological features, and treatment strategies, aiming to provide a reference basis for clinical practice.