Reversible renal-limited thrombotic microangiopathy due to gemcitabine-dexamethasone-cisplatin therapy: a case report
Abstract Background Gemcitabine and cisplatin are chemotherapeutic agents used for treating multiple cancers, and these agents are sometimes used in combination. Drug-induced thrombotic microangiopathy (TMA) is a rare but potentially fatal complication. It typically presents as a systemic disease wi...
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| Format: | Article |
| Language: | English |
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BMC
2021-05-01
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| Series: | BMC Nephrology |
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| Online Access: | https://doi.org/10.1186/s12882-021-02386-y |
| _version_ | 1818456537339789312 |
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| author | Masashi Nishikubo Yoshimitsu Shimomura Nobuhiro Hiramoto Naohiko Sawamura Takako Yamaguchi Shigeo Hara Takayuki Ishikawa |
| author_facet | Masashi Nishikubo Yoshimitsu Shimomura Nobuhiro Hiramoto Naohiko Sawamura Takako Yamaguchi Shigeo Hara Takayuki Ishikawa |
| author_sort | Masashi Nishikubo |
| collection | DOAJ |
| description | Abstract Background Gemcitabine and cisplatin are chemotherapeutic agents used for treating multiple cancers, and these agents are sometimes used in combination. Drug-induced thrombotic microangiopathy (TMA) is a rare but potentially fatal complication. It typically presents as a systemic disease with the classical triad of hemolytic anemia, thrombocytopenia, and organ damage. In contrast to systemic TMA, cases of renal-limited TMA, defined as biopsy-proven renal TMA without the classical triad, have been reported with relatively good prognosis. Most cases of renal-limited TMA are associated with calcineurin inhibitors, and cases of drug-induced renal-limited TMA due to gemcitabine-dexamethasone-cisplatin therapy have been rarely reported. Case presentation A 43-year-old woman with lymphoma developed acute kidney injury with marked proteinuria, microhematuria, and abnormal urinary casts after receiving one cycle of gemcitabine-dexamethasone-cisplatin therapy. Although she did not show hemolytic anemia and thrombocytopenia, renal biopsy showed diffuse injury to the glomerular endothelial cells, supporting the diagnosis of renal-limited TMA. Her condition improved only with the cessation of gemcitabine and cisplatin treatment. She received another chemotherapy without gemcitabine and platinum agents, and no recurrence of renal-limited TMA was observed. Conclusions Drug-induced TMA occurs early after gemcitabine and cisplatin use in renal-limited form and is reversible when detected and managed in a timely manner. Urinalysis, which is simple and inexpensive and can be easily performed, is a beneficial screening tool for early-onset drug-induced TMA among patients who receive gemcitabine-dexamethasone-cisplatin therapy. |
| first_indexed | 2024-12-14T22:28:15Z |
| format | Article |
| id | doaj.art-8a2b8a430853462da77da71c8290823a |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-12-14T22:28:15Z |
| publishDate | 2021-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-8a2b8a430853462da77da71c8290823a2022-12-21T22:45:17ZengBMCBMC Nephrology1471-23692021-05-012211610.1186/s12882-021-02386-yReversible renal-limited thrombotic microangiopathy due to gemcitabine-dexamethasone-cisplatin therapy: a case reportMasashi Nishikubo0Yoshimitsu Shimomura1Nobuhiro Hiramoto2Naohiko Sawamura3Takako Yamaguchi4Shigeo Hara5Takayuki Ishikawa6Department of Hematology, Kobe City Medical Center General HospitalDepartment of Hematology, Kobe City Medical Center General HospitalDepartment of Hematology, Kobe City Medical Center General HospitalDepartment of Nephrology, Kobe City Medical Center General HospitalDepartment of Pathology, Kobe City Medical Center General HospitalDepartment of Pathology, Kobe City Medical Center General HospitalDepartment of Hematology, Kobe City Medical Center General HospitalAbstract Background Gemcitabine and cisplatin are chemotherapeutic agents used for treating multiple cancers, and these agents are sometimes used in combination. Drug-induced thrombotic microangiopathy (TMA) is a rare but potentially fatal complication. It typically presents as a systemic disease with the classical triad of hemolytic anemia, thrombocytopenia, and organ damage. In contrast to systemic TMA, cases of renal-limited TMA, defined as biopsy-proven renal TMA without the classical triad, have been reported with relatively good prognosis. Most cases of renal-limited TMA are associated with calcineurin inhibitors, and cases of drug-induced renal-limited TMA due to gemcitabine-dexamethasone-cisplatin therapy have been rarely reported. Case presentation A 43-year-old woman with lymphoma developed acute kidney injury with marked proteinuria, microhematuria, and abnormal urinary casts after receiving one cycle of gemcitabine-dexamethasone-cisplatin therapy. Although she did not show hemolytic anemia and thrombocytopenia, renal biopsy showed diffuse injury to the glomerular endothelial cells, supporting the diagnosis of renal-limited TMA. Her condition improved only with the cessation of gemcitabine and cisplatin treatment. She received another chemotherapy without gemcitabine and platinum agents, and no recurrence of renal-limited TMA was observed. Conclusions Drug-induced TMA occurs early after gemcitabine and cisplatin use in renal-limited form and is reversible when detected and managed in a timely manner. Urinalysis, which is simple and inexpensive and can be easily performed, is a beneficial screening tool for early-onset drug-induced TMA among patients who receive gemcitabine-dexamethasone-cisplatin therapy.https://doi.org/10.1186/s12882-021-02386-yThrombotic microangiopathiesGemcitabineCisplatinUrinalysisLymphomaProteinuria |
| spellingShingle | Masashi Nishikubo Yoshimitsu Shimomura Nobuhiro Hiramoto Naohiko Sawamura Takako Yamaguchi Shigeo Hara Takayuki Ishikawa Reversible renal-limited thrombotic microangiopathy due to gemcitabine-dexamethasone-cisplatin therapy: a case report BMC Nephrology Thrombotic microangiopathies Gemcitabine Cisplatin Urinalysis Lymphoma Proteinuria |
| title | Reversible renal-limited thrombotic microangiopathy due to gemcitabine-dexamethasone-cisplatin therapy: a case report |
| title_full | Reversible renal-limited thrombotic microangiopathy due to gemcitabine-dexamethasone-cisplatin therapy: a case report |
| title_fullStr | Reversible renal-limited thrombotic microangiopathy due to gemcitabine-dexamethasone-cisplatin therapy: a case report |
| title_full_unstemmed | Reversible renal-limited thrombotic microangiopathy due to gemcitabine-dexamethasone-cisplatin therapy: a case report |
| title_short | Reversible renal-limited thrombotic microangiopathy due to gemcitabine-dexamethasone-cisplatin therapy: a case report |
| title_sort | reversible renal limited thrombotic microangiopathy due to gemcitabine dexamethasone cisplatin therapy a case report |
| topic | Thrombotic microangiopathies Gemcitabine Cisplatin Urinalysis Lymphoma Proteinuria |
| url | https://doi.org/10.1186/s12882-021-02386-y |
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