| Renal failure due to scleroderma with thrombotic microangiopathy developing in a woman treated with carboplatin for ovarian cancer. | |
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MedLine Citation:
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PMID: 12425490 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Acute renal failure in association with microangiopathic hemolytic anemia and the pathological finding of thrombotic microangiopathy may occur in a number of conditions including hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, and systemic sclerosis. Distinguishing between these conditions on clinical grounds may be difficult, and further investigations, including serological tests, are normally helpful. We present a patient who was treated with 5 doses of monthly carboplatin chemotherapy for stage IIb ovarian carcinoma and who subsequently developed acute renal failure and microangiopathic hemolysis together with some cutaneous features of systemic sclerosis. Initial serological tests, including anti-nuclear antibody titers measured using rat hepatocytes, were normal, and renal biopsy showed features of microangiopathic hemolysis, fibrinoid change, patchy tubular atrophy, and concentric intimal proliferation. A clinical diagnosis of diarrhea-negative hemolytic uremic syndrome was made and she was treated with plasma exchange and fresh frozen plasma infusion. However, she remained dialysis-dependent. Several weeks later she died following a cardiac arrest. Post-mortem examination revealed medial hypertrophy, concentric intimal proliferation, and thrombi within the small arteries of the kidneys and lungs. Subsequent results from tests taken at the time of her presentation with acute renal failure revealed a normal von Willebrand factor qualitative distribution, and a positive anti-nuclear antibody titer (using a human cell line) in association with positive autoantibodies to RNA polymerase types I, II, and III. Taken together, the clinical, laboratory, and post-mortem findings were suggestive of a diagnosis of systemic sclerosis. We discuss the differential diagnoses, and the associations between these and malignancy and chemotherapy. Finally, we consider the serological tests used for the diagnosis of systemic sclerosis that were, in this case, initially misleading. |
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Authors:
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M Karim; E Vaux; D R Davies; P D Mason |
Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: Clinical nephrology Volume: 58 ISSN: 0301-0430 ISO Abbreviation: Clin. Nephrol. Publication Date: 2002 Nov |
Date Detail:
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Created Date: 2002-11-11 Completed Date: 2003-02-25 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0364441 Medline TA: Clin Nephrol Country: Germany |
Other Details:
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Languages: eng Pagination: 384-8 Citation Subset: IM |
Affiliation:
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Oxford Kidney Unit, Churchill Hospital, UK. mkarim@doctors.org.uk |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Anemia, Hemolytic
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chemically induced*,
complications*,
pathology Antineoplastic Agents / adverse effects*, therapeutic use* Carboplatin / adverse effects*, therapeutic use* Carcinoma / drug therapy*, pathology Female Humans Kidney Failure, Acute / etiology*, pathology Middle Aged Ovarian Neoplasms / drug therapy*, pathology Scleroderma, Systemic / chemically induced*, complications*, pathology Thrombosis / chemically induced*, complications*, pathology |
| Chemical | |
Reg. No./Substance:
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0/Antineoplastic Agents; 41575-94-4/Carboplatin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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