Kidney Week

Abstract: PUB246

Gemcitabine-Induced TMA: A Rare Side Effect Associated with High Mortality: A Case Report of Partial Response to Eculizumab

Session Information

• Publication Only

Category: Trainee Case Report

• 1500 Onco-Nephrology

Authors

• Mattiotti, Maria, Universita di Bologna, Bologna, Emilia-Romagna, Italy

Maria Mattiotti,

• Napoli, Marianna, Universita di Bologna, Bologna, Emilia-Romagna, Italy

Marianna Napoli,

• Campus, Anita, Universita di Bologna, Bologna, Emilia-Romagna, Italy

Anita Campus,

• Stefanini, Carlo, Universita di Bologna, Bologna, Emilia-Romagna, Italy

Carlo Stefanini,

• Vischini, Gisella, Universita di Bologna, Bologna, Emilia-Romagna, Italy

Gisella Vischini,

• Baraldi, Olga, Universita di Bologna, Bologna, Emilia-Romagna, Italy

Olga Baraldi,

• Fabbrizio, Benedetta, Universita di Bologna, Bologna, Emilia-Romagna, Italy

Benedetta Fabbrizio,

• La Manna, Gaetano, Universita di Bologna, Bologna, Emilia-Romagna, Italy

Gaetano La Manna,

Introduction

Thrombotic Microangiopathy (TMA) is a well-known complication in cancer, and it could be secondary to neoplasm itself or to its treatment. Gemcitabine-induced TMA is rare, but associated with high mortality rate and negative renal prognosis.

Case Description

A 71-year-old woman treated with Gemcitabine for recurrence of endometroid carcinoma developed a rapid progressive kidney injury, hypertension and pulmonary edema. Laboratory tests revealed signs of TMA. Histological analysis showed both acute and chronic TMA signs (Fig. 1). Upon suspicion of GiTMA, antiblastic therapy was discontinued and, in order to prevent complement activation, Eculizumab was administered. According to literature, a sudden improvement of blood count was observed. Because of worsening of renal function, dialytical treatment was started. Histologically chronical lesions were documented (Fig.2).

Discussion

GiTMA is mostly misdiagnosed, because blood count instability and renal impairment could recognised multiple triggers in neoplastic patients. An early diagnosis enables drug withdrawal and complement system inhibition: the only measures that seem to be associated with increased survival and a better renal outcome.

Focal mesangiolysis, glomerular basement membrane reduplication (Silver Jones stain; 400x)

Mesangiolysis, endocapillary proliferation (arrow), glomerular basement membrane reduplication; arteriole (asterisks) free from TMA signs (PAS stain; 400x)