OBJECTIVE
To describe 6 patients who developed progressive renal failure and renal thrombotic
microangiopathy (TM) not accompanied by the characteristic hematologic disturbances
of TM syndromes.
Patients and Methods
Portions of renal biopsy specimens from each patient were examined by light and electron
microscopy for histopathologic evidence of TM. Antecedent clinical events, laboratory
evidence of hemolysis and thrombocytopenia, and clinical outcome were documented.
Medical records were reviewed and clinical data, including laboratory values, treatment,
and outcome, were recorded.
Results
In each case, a slowly progressive uremia evolved after radiation and/or chemotherapy
without laboratory evidence of acute hemolysis or thrombocytopenia. Renal biopsy specimens
in all cases showed TM and tubulointerstitial scarring, suggesting both acute and
chronic renal injury. Two of the 6 patients underwent plasma exchange therapy without
improvement of renal function. Three patients treated with angiotensin-converting
enzyme inhibitors for coexisting systemic hypertension remained stable or had mild
improvement in renal function.
Conclusions
A small subset of patients treated for malignancy developed slowly evolving uremia
associated with renal TM without marked hematologic abnormalities. In the absence
of thrombocytopenia and other typical laboratory findings, the diagnosis of renal
TM may be overlooked.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Mayo Clinic ProceedingsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- A syndrome of microangiopathic hemolytic anemia, renal impairment, and pulmonary edema in chemotherapy-treated patients with adenocarcinoma.Cancer. 1986; 58: 1428-1436
- Thrombotic microangiopathy and renal failure associated with antineoplastic chemotherapy.Ann Intern Med. 1984; 101: 41-44
- Plasma exchange and vincristine in the treatment of hemolytic uremic syndrome/thrombotic thrombocytopenic purpura associated with bone marrow transplantation.J Clin Apheresis. 1991; 6: 16-20
- Intravascular hemolysis and renal insufficiency after bone marrow transplantation.Blood. 1988; 72: 451-455
- Haemolytic uraemic syndrome after bone marrow transplantation: an adverse effect of total body irradiation?.Bone Marrow Transplant. 1988; 3: 339-347
- Thrombotic microangiopathy in the cancer patient including those induced by chemotherapeutic agents.Semin Hematol. 1987; 24: 161-177
- Miscellaneous secondary thrombotic microangiopathy.Semin Hematol. 1987; 24: 141-147
- Hemolytic-uremic syndrome following bone marrow transplantation in adults for hematologic malignancies.Blood. 1991; 77: 1837-1844
- Cancer-associated hemolytic-uremic syndrome: analysis of 85 cases from a national registry.J Clin Oncol. 1989; 7: 781-789
- Hemolytic uremic syndrome following bone marrow transplantation: a case report and review of the literature.Am J Kidney Dis. 1989; 14: 324-328
- A case of thrombotic thrombocytopenic purpura following allogeneic bone marrow transplantation.Bone Marrow Transplant. 1990; 5: 61-63
- Clinical course of late-onset bone marrow transplant nephropathy.Nephron. 1993; 64: 626-635
- Thrombotic microangiopathy following bone marrow transplantation.Bone Marrow Transplant. 1994; 14: 495-504
- Mesangiolysis: an important glomerular lesion in thrombotic microangiopathy.Mod Pathol. 1991; 4: 161-166
- Thrombotic microangiopathy including hemolytic uremic syndrome, thrombotic thrombocytopenic purpura and postpartum renal failure.in: Tisher CC Brenner BM Renal Pathology With Clinical and Functional Correlations. JB Lippincott Co, Philadelphia, Pa1989: 1081-1113
- von Willebrand factor proteolysis is deficient in classic, but not in bone marrow transplantation-associated, thrombotic thrombocytopenic purpura.Blood. 1999; 93: 3798-3802
- Thrombotic microangiopathies in the 1980s: clinical features, response to treatment, and the impact of the human immunodeficiency virus epidemic.Blood. 1992; 80: 1890-1895
- Therapeutic plasma exchange does not appear to be effective in the management of thrombotic thrombocytopenic purpura/hemolytic uremic syndrome following bone marrow transplantation.Bone Marrow Transplant. 1995; 16: 271-275
- Thrombotic thrombocytopenic purpura: a simpler diagnosis at last? [letter].Thromb Haemost. 1999; 82: 1380-1381
- von Willebrand factor in thrombotic thrombocytopenic purpura.Thromb Haemost. 1999; 82: 592-600
- Changes in the natural anticoagulants following bone marrow transplantation.Bone Marrow Transplant. 1990; 5: 39-42
- High frequency of antithrombin 3 and protein C deficiency following autologous bone marrow transplantation for lymphoma.Bone Marrow Transplant. 1991; 8: 497-502
- Protein C deficiency following hematopoietic stem cell transplantation (HSCT): optimization of intravenous (IV) vitamin K (VK) dose [abstract].Blood. 1992; 80 (Abstract 2083.): 523a
- Cerebral infarction associated with protein C deficiency following allogeneic bone marrow transplantation.Bone Marrow Transplant. 1991; 8: 323-325
- Protein C (PC) deficiency during marrow transplantation: a frequent occurrence associated with a decrease in PC antigen and production of a dysfunctional PC molecule [abstract].Blood. 1991; 78 (Abstract 1141.): 288a
- Renal vascular lesions after chemotherapy with vinblastine, bleomycin, and cisplatin.Am J Med. 1982; 73: 429-433
- Delayed renal failure with extensive mesangiolysis following bone marrow transplantation.Kidney Int. 1989; 35: 1336-1344
- Treatment of radiation nephropathy with ACE inhibitors.Int J Radiat Oncol Biol Phys. 1993; 27: 93-99
- Treatment of radiation nephropathy with captopril.Radiat Res. 1992; 132: 346-350
- Radiation nephropathy: a review.Scanning Microsc. 1995; 9: 535-560
- Noncontinuous use of angiotensin converting enzyme inhibitors in the treatment of experimental bone marrow transplant nephropathy.Bone Marrow Transplant. 1997; 19: 729-735
- Stimulation of plasminogen activator inhibitor in vivo by infusion of angiotensin II: evidence of a potential interaction between the renin-angiotensin system and fibrinolytic function.Circulation. 1993; 87: 1969-1973
- Angiotensin II regulates the expression of plasminogen activator inhibitor-1 in cultured endothelial cells: a potential link between the renin-angiotensin system and thrombosis.J Clin Invest. 1995; 95: 995-1001
- Angiotensin II induces secretion of plasminogen activator inhibitor 1 and a tissue metalloprotease inhibitor-related protein from rat brain astrocytes.Proc Natl Acad Sci U S A. 1991; 88: 1928-1932
- Effects of captopril therapy on endogenous fibrinolysis in men with recent, uncomplicated myocardial infarction.J Am Coll Cardiol. 1994; 24: 67-73
- Improvement in endothelial function by angiotensin-converting enzyme inhibition in insulin-dependent diabetes mellitus.J Clin Invest. 1997; 100: 678-684
- Effect of the angiotensin-converting-enzyme inhibitor benazepril on the progression of chronic renal insufficiency.N Engl J Med. 1996; 334: 939-945
Article Info
Identification
Copyright
© 2002 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.