Diffuse endothelial swelling, mesangiolysis and capillary loop thrombi in combination with podocyte VEGF downregulation in our patient resemble renal TMA seen in cancer patients treated with VEGF inhibitors [15] or preeclampsia patients with increased circulating level of soluble fms-like tyrosine kinase 1 (sFlt1), a soluble VEGF receptor and an antagonist of VEGF [16]. The gene discussed is VEGFA; the disease is cancer.