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      Síndrome hemolítico-urémico asociado al uso de gemcitabina: Caso clínico Translated title: Hemolytic-uremic syndrome associated with gemcitabine use: Report of one case

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          Translated abstract

          Gemcitabine is a widely used drug in the treatment of advanced pancreatic cancer and other malignancies. It is generally well tolerated and exceptionally its use has been associated with hemolytic-uremic syndrome, causing acute kidney injury, hipertension, chronic renal failure requiring dialysis, and death. We report a 60-year-old man with pancreatic carcinoma and regional lymph node invasion, whom after four months of therapy with gemcitabine and after dose number 11, suddenly developed an acute nephritic syndrome with moderate renal impairment, associated with severe anemia (hemoglobin 6.0 g/dL) and thrombocytopenia (20,000 mm³). Renal biopsy showed the classic findings of thrombotic microangiopathy Gemcitabine was discontinued and renal function and hematological parameters gradually improved.

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          Hemolytic uremic syndrome.

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            Gemcitabine-induced thrombotic microangiopathy: a systematic review.

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              Gemcitabine nephrotoxicity and hemolytic uremic syndrome: report of 29 cases from a single institution.

              Gemcitabine is used in a variety of advanced malignancies. Hemolytic uremic syndrome has been reported as a side effect. we reviewed medical records of 29 patients with gemcitabine nephrotoxicity. The median cumulative dose of gemcitabine was 22 g/m2 (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. 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.
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                Author and article information

                Journal
                rmc
                Revista médica de Chile
                Rev. méd. Chile
                Sociedad Médica de Santiago (Santiago, , Chile )
                0034-9887
                June 2013
                : 141
                : 6
                : 797-802
                Affiliations
                [04] Viña del Mar orgnameHospital Naval A. Nef orgdiv1Servicio de Anestesiología Chile
                [03] Viña del Mar orgnameHospital Naval A. Nef orgdiv1Servicios de Medicina Chile
                [01] Viña del Mar orgnameHospital Dr. Gustavo Fricke orgdiv1Servicio de Medicina Chile
                [02] Valparaíso orgnameUniversidad de Valparaíso orgdiv1Escuela de Medicina Chile
                [05] Santiago orgnamePontificia Universidad Católica de Chile orgdiv1Departamento de Anatomía Patológica Chile
                Article
                S0034-98872013000600016 S0034-9887(13)14100600016
                10.4067/S0034-98872013000600016
                77a641de-3d16-4b2b-bd27-94f3b73a8398

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 25 September 2012
                : 16 January 2013
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 26, Pages: 6
                Product

                SciELO Chile

                Categories
                CASOS CLINICOS

                Gemcitabine,Anemia,Acute kidney injury,Pancreatic neoplasms,Hemolytic-uremic syndrome,Antimetabolites, antineoplastic

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