Katagiri Daisuke, Hinoshita Fumihiko
Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Nephrology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, 162-8655, Tokyo, Japan.
CEN Case Rep. 2018 Nov;7(2):217-220. doi: 10.1007/s13730-018-0332-3. Epub 2018 May 15.
We encountered a case of gemcitabine (GEM)-induced secondary thrombotic microangiopathy (TMA) with nephrotic syndrome. Advanced pancreatic cancer with liver metastasis had originally been diagnosed. Renal biopsy showed focal reduplication of the glomerular basement membrane, endothelial cell swelling, and narrowed capillary lumens with fragmented erythrocytes and fibrin deposition, compatible with TMA. Regular monitoring of renal function during GEM treatment and discontinuation of treatment if acute kidney injury (AKI) might occur is crucial, because AKI combined with TMA is life-threatening.
我们遇到了一例吉西他滨（GEM）诱发的继发性血栓性微血管病（TMA）合并肾病综合征的病例。最初诊断为晚期胰腺癌伴肝转移。肾活检显示肾小球基底膜局灶性重复、内皮细胞肿胀、毛细血管腔狭窄，伴有破碎红细胞和纤维蛋白沉积，符合TMA表现。在GEM治疗期间定期监测肾功能，若可能发生急性肾损伤（AKI）则停止治疗至关重要，因为AKI合并TMA会危及生命。
