Gemcitabine nephrotoxicity and hemolytic uremic syndrome: Report of 29 cases from a single institution Journal Article
| Authors: | Glezerman, I.; Kris, M. G.; Miller, V.; Seshan, S.; Flombaum, C. D. |
| Article Title: | Gemcitabine nephrotoxicity and hemolytic uremic syndrome: Report of 29 cases from a single institution |
| Abstract: | Background: Gemcitabine is used in a variety of advanced malignancies. Hemolytic uremic syndrome has been reported as a side effect. Methods: we reviewed medical records of 29 patients with gemcitabine nephrotoxicity. Results: The median cumulative dose of gemcitabine was 22 g/m<sup>2</sup> (4-81) given over 7.5 months (2-34). Prior chemotherapy with mitomycin had been given to 9 patients, and in 4 the hemolytic uremic syndrome was particularly severe and appeared shortly after gemcitabine initiation All patients had renal insufficiency. Microhematuria and proteinuria were present in 27 patients and red blood cell casts were seen in 8. Renal biopsies in 4 patients showed thrombotic microangiopathy. Worsening or new-onset hypertension was seen in 26 patients. Edema, shortness of breath and congestive heart failure were present in 21, 15 and 7 patients, respectively. All had anemia, thrombocytopenia and elevated serum lactate dehydrogenase. Haptoglobin was low in 23 of the 26 patients who had it measured. Schistocytes were present in 21 of the 24 patients who had blood smear reviewed. Gemcitabine was discontinued once hemolytic uremic syndrome was recognized. Full or partial recovery of renal function occurred in 19 patients. 7 patients progressed to end-stage renal disease and 3 patients developed chronic renal failure. Conclusions: Gemcitabine nephrotoxicity presents as new-onset renal disease with associated hypertension, thrombocytopenia and microangiopathic hemolytic anemia. Prior chemotherapy with mitomycin, especially when given in close proximity, may be synergistic. A high index of suspicion is essential to make an early diagnosis. Stopping gemcitabine improves the outcome. © 2009 Dustri-Verlag Dr. K. Feistle. |
| Keywords: | clinical article; clinical feature; disease course; mortality; review; cisplatin; cancer combination chemotherapy; drug potentiation; drug withdrawal; hypertension; monotherapy; side effect; gemcitabine; pancreas cancer; outcome assessment; metabolism; carboplatin; edema; nephrotoxicity; breast cancer; anemia; antimetabolites, antineoplastic; thrombocytopenia; lung cancer; creatinine; creatinine blood level; kidney failure; urea nitrogen blood level; medical record review; bladder cancer; hematuria; vinblastine; docetaxel; dyspnea; sarcoma; cause of death; drug fatality; disease progression; chemically induced disorder; drug derivative; antihypertensive agent; lactate dehydrogenase; seizure; mitomycin; drug treatment failure; deoxycytidine; antineoplastic antimetabolite; hemodialysis; brain hematoma; hemolytic uremic syndrome; microangiopathic anemia; renal failure; exatecan; haptoglobin; recombinant erythropoietin; brain hemorrhage; cholecystitis; congestive heart failure; disease exacerbation; hemiparesis; kidney biopsy; lactate dehydrogenase blood level; leg edema; proteinuria; thrombotic thrombocytopenic purpura; renovascular hypertension; hemolytic-uremic syndrome; hypertension, renal; l-lactate dehydrogenase |
| Journal Title: | Clinical Nephrology |
| Volume: | 71 |
| Issue: | 2 |
| ISSN: | 0301-0430 |
| Publisher: | Dustri-Verlag Dr. Karl Feistle |
| Date Published: | 2009-02-01 |
| Start Page: | 130 |
| End Page: | 139 |
| Language: | English |
| PUBMED: | 19203505 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 2" - "Export Date: 30 November 2010" - "CODEN: CLNHB" - "Source: Scopus" |
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