title: Massive hematuria from the bilateral upper urinary tract in a patient treated for advanced lung cancer with gefitinib.
abstract: We report a case of gefitinib-induced bilateral upper urinary tract bleeding in an 82-year-old woman administered the drug daily for advanced non-small cell adenocarcinoma of the lung (T4N3M0). Hematuria is an uncommon adverse effect of gefitinib, and in most cases, the bleeding site is unknown. On the 44th day of oral gefitinib administration, the patient noted asymptomatic macroscopic bloody urine. Cystoscopy revealed bleeding from the bilateral ureteric orifices without hemorrhagic inflammation of the bladder. One week later, she was admitted complaining of severe abdominal pain, and her condition was found to be complicated by liver damage and renal dysfunction. We stopped gefitinib administration and started hydration and diuresis. Renal function and urine output soon recovered, and at the request of the patient, we restarted gefitinib, administering it every other day, which was sufficient to maintain antitumor activity and stabilize the disease. On the 41st day after restarting gefitinib, hematuria and proteinuria reappeared. We therefore stopped the gefitinib, and the patient was followed with supportive care. The patient's autopsy findings denied organic urologic diseases. Instead, the reproducibility of the hematuria from the upper urinary system strongly suggests an unexpected gefitinib-related adverse effect.
authors.affiliation: Second Department of Internal Medicine, Gifu University Graduate School of Medicine, Yanagido 1-1, 501-1194 Gifu, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Mori
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ohno
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Ito
authors.forename: Norihiko
authors.initials: N
authors.lastname: Funaguchi
authors.forename: Komei
authors.initials: K
authors.lastname: Yanase
authors.forename: Junki
authors.initials: J
authors.lastname: Endo
authors.forename: Masahiro
authors.initials: M
authors.lastname: Nakano
authors.forename: Bu Lin
authors.initials: BL
authors.lastname: Bai La
authors.forename: Shinya
authors.initials: S
authors.lastname: Minatoguchi
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects*; D066246:ErbB Receptors / Q000037:antagonists & inhibitors; D005260:Female; D000077156:Gefitinib; D006417:Hematuria / Q000139:chemically induced* / Q000473:pathology; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology; D011379:Prognosis; D011799:Quinazolines / Q000009:adverse effects*; D016896:Treatment Outcome; D014551:Urinary Tract / Q000187:drug effects* / Q000473:pathology
chemical_list: D000970:Antineoplastic Agents; D011799:Quinazolines; D066246:ErbB Receptors; D000077156:Gefitinib