What happened, in summary

A 68-year-old woman underwent hysterectomy, removal of both ovaries and fallopian tubes, omental surgery, and lymph-node dissection for ovarian cancer in June 2016. Pathology showed high-grade serous adenocarcinoma classified as pT3N1M1, Stage IVB. Her urine testing had been normal before surgery.

She began carboplatin, paclitaxel, and bevacizumab in July 2016. Protein appeared in her urine and her blood pressure rose after 3 courses. Proteinuria persisted through 6 courses. In June 2017, the ovarian cancer returned with peritoneal dissemination and a left lymph-node metastasis, and she began gemcitabine with carboplatin.

After the eighth course, she developed leg swelling and was admitted in March 2018. Testing showed nephrotic syndrome, with urinary protein of 6.75 g/gCr and serum albumin of 2.7 g/dL. Kidney biopsy findings supported glomerular microangiopathy associated with bevacizumab, although gemcitabine-related injury could not be excluded. Prednisolone and mycophenolate did not produce a response and were tapered, after which supportive treatment continued.

About 10 months after the biopsy, the kidney condition reached partial remission. During the same period, no further progression of the ovarian cancer was observed.