[Hemolytic-uremic syndrome caused by mitomycin c: long-term management].

Clinique de Néphrologie, Hôpital d'Instruction des Armées du Val-de-Grâce, Paris.
Annales de medecine interne 03/2000; 151(1):70-3.
Source: PubMed


We describe the case of a 51-year-old woman who developed a hemolytic uremic syndrome nine weeks after the end of chemotherapy with mitomycin C for cancer of the anus. Episodes of hemolytic uremic syndrome recurred within a period of up to six months. They were treated with plasma infusion and exchange, antiplatelet agents and rigorous control of blood pressure. The patient was followed for eight years. Her blood pressure has been normal without the use of antihypertensive agents and the renal function has remained stable with serum creatinine at 110 mumol/1. The tumor has remained in remission. This case suggests that recovery from the acute phase of hemolytic uremic syndrome leads to good long-term prognosis.

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    ABSTRACT: A 58-year-old normotensive male with normal renal function and gastric cancer underwent total gastrectomy and received adjuvant chemotherapy with mitomycin C (MMC) for 10 months. He developed anemia, hypertension, and renal function impairment 9 months after initiation of chemotherapy. Kidney biopsy showed thrombotic microangiopathy with marked mesangiolysis and expansion of the subendothelial space resulting in cystic dilation of the glomerular capillaries, and cellular atypia in the tubular cells. His renal function deteriorated gradually then stabilized after treatment with plasma exchange, antihypertensive agents, and antiplatelet agents. He had no sign of tumor recurrence after 3 years of follow-up. We suggest that patients receiving MMC should have their blood pressure and renal function closely monitored for the possibility of development of drug-induced renal insufficiency.
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