Document Detail

Renal failure due to scleroderma with thrombotic microangiopathy developing in a woman treated with carboplatin for ovarian cancer.
MedLine Citation:
PMID:  12425490     Owner:  NLM     Status:  MEDLINE    
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.
M Karim; E Vaux; D R Davies; P D Mason
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Clinical nephrology     Volume:  58     ISSN:  0301-0430     ISO Abbreviation:  Clin. Nephrol.     Publication Date:  2002 Nov 
Date Detail:
Created Date:  2002-11-11     Completed Date:  2003-02-25     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0364441     Medline TA:  Clin Nephrol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  384-8     Citation Subset:  IM    
Oxford Kidney Unit, Churchill Hospital, UK.
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MeSH Terms
Anemia, Hemolytic / chemically induced*,  complications*,  pathology
Antineoplastic Agents / adverse effects*,  therapeutic use*
Carboplatin / adverse effects*,  therapeutic use*
Carcinoma / drug therapy*,  pathology
Kidney Failure, Acute / etiology*,  pathology
Middle Aged
Ovarian Neoplasms / drug therapy*,  pathology
Scleroderma, Systemic / chemically induced*,  complications*,  pathology
Thrombosis / chemically induced*,  complications*,  pathology
Reg. No./Substance:
0/Antineoplastic Agents; 41575-94-4/Carboplatin

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