Published online Oct 26, 2018. doi: 10.12998/wjcc.v6.i12.531
Peer-review started: May 5, 2018
First decision: July 9, 2018
Revised: September 8, 2018
Accepted: October 9, 2018
Article in press: October 9, 2018
Published online: October 26, 2018
Gemcitabine is an antineoplastic used to treat several malignancies including pancreatic cancer. Its toxicity profile is well known with myelotoxicity, increased vascular permeability and peripheral oedema as most frequent adverse events. However, several cases of acute renal failure have been reported and haemolytic uremic syndrome (HUS) seems to be the underlying process. The cause of HUS remains unknown but its consequences can be lethal. Therefore, a high grade of suspicion is crucial to diagnose it and promptly treat it. This hopefully will reduce its morbidity. HUS is characterized by progressive renal failure associated with microangiopathic haemolytic anaemia and thrombocytopenia. The primary event is damage to endothelial cells and thrombotic microangiopathy (TMA) is the histopathological lesion. TMA affects mainly renal microvasculature. However, some cases evolve with central nervous or cardiovascular systems involvement. We present here a case of gemcitabine-induced HUS, with renal and cardiovascular system affected at the time of diagnosis which to our knowledge this is the first time of such case to be reported.
Core tip: Gemcitabine has a well-known toxicity profile though rare cases of acute renal failure caused by haemolytic uremic syndrome (HUS) have also been reported. The cause of HUS remains unknown but its consequences may be lethal. HUS consists of progressive renal failure with microangiopathic haemolytic anaemia and thrombocytopenia. Thrombotic microangiopathy is the histopathological lesion and this affects mainly renal microvasculature. We present a case of gemcitabine-induced HUS and review literature to make professionals fully aware of its existence, thus a high grade of suspicion might help with early diagnosis and prompt treatment which hopefully will reduce its morbidity.