A case of gemcitabine-induced thrombotic microangiopathy in a urothelial tumor patient with a single kidney

Kidney Research and Clinical Practice
Hyunjin RyuHajeong Lee

Abstract

Thrombotic microangiopathy (TMA) is a rare complication of gemcitabine treatment. A 55-year-old man with a history of urothelial cancer underwent right ureteronephrectomy and palliative chemotherapy. The patient presented with dyspnea, generalized edema with foamy urine, and new-onset hypertension with acute kidney injury (AKI). Although AKI with oliguria was evident, thrombocytopenia and hemolytic anemia were not overt. To determine the cause of rapidly progressive azotemia, kidney biopsy was performed despite a single kidney and revealed chronic TMA. Microangiopathic hemolytic anemia and thrombocytopenia developed after renal biopsy. Diagnosed as gemcitabine-induced TMA, gemcitabine cessation and active treatment including steroids, plasmapheresis, and rituximab were carried out, but the patient׳s condition progressed to a dialysis-dependent state. Gemcitabine-induced TMA is often difficult to diagnose because of its variable clinical course. Therefore, heightened awareness of this potentially lethal complication of gemcitabine is essential; renal biopsy may be helpful.

References

Jul 7, 2007·The Lancet Oncology·Melanie ZupancicFarheen Shah-Khan
Nov 6, 2008·Expert Opinion on Drug Safety·Constantin A Dasanu
May 15, 2010·Clinical & Translational Oncology : Official Publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico·Irene Moya-HornoCarles Pericay Pijaume
Mar 18, 2011·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Jacob G ThomasSuzanne M Norby

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Citations

Jul 13, 2016·Advances in Anatomic Pathology·Megan L TroxellNeeraja Kambham

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Methods Mentioned

BETA
biopsy

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