title: Gemcitabine-induced hemolytic uremic syndrome mimicking scleroderma renal crisis presenting with Raynaud's phenomenon, positive antinuclear antibodies and hypertensive emergency.
abstract: A 58-year-old woman who received gemcitabine for advanced gallbladder cancer developed an impaired renal function, thrombocytopenia, Raynaud's phenomenon, digital ischemic changes, a high antinuclear antibody titer and hypertensive emergency that mimicked a scleroderma renal crisis. A kidney biopsy specimen demonstrated onion-skin lesions in the arterioles and small arteries along with ischemic changes in the glomeruli, compatible with a diagnosis of hypertensive emergency (malignant hypertension). The intravenous administration of a calcium channel blocker, the oral administration of an angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker and the transfusion of fresh frozen plasma were effective for treating the thrombocytopenia and progressive kidney dysfunction. Gemcitabine induces hemolytic uremic syndrome with accelerated hypertension and Raynaud's phenomenon, mimicking scleroderma renal crisis.
authors.affiliation: Division of Nephrology and Rheumatology, Department of Internal Medicine, Aichi Medical University School of Medicine, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Yamada
authors.forename: Keisuke
authors.initials: K
authors.lastname: Suzuki
authors.forename: Hironobu
authors.initials: H
authors.lastname: Nobata
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Kawai
authors.forename: Ryo
authors.initials: R
authors.lastname: Wakamatsu
authors.forename: Naoto
authors.initials: N
authors.lastname: Miura
authors.forename: Shogo
authors.initials: S
authors.lastname: Banno
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Imai
mesh_terms: D000974:Antibodies, Antinuclear / Q000097:blood; D001794:Blood Pressure / Q000502:physiology; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004630:Emergencies; D005260:Female; D005706:Gallbladder Neoplasms / Q000188:drug therapy; D006463:Hemolytic-Uremic Syndrome / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis; D006801:Humans; D006974:Hypertension, Malignant / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007678:Kidney Glomerulus / Q000473:pathology; D008875:Middle Aged; D011928:Raynaud Disease / Q000097:blood / Q000175:diagnosis*; D012264:Ribonucleotide Reductases / Q000037:antagonists & inhibitors; D012595:Scleroderma, Systemic / Q000175:diagnosis*; D000093542:Gemcitabine
chemical_list: D000974:Antibodies, Antinuclear; D007166:Immunosuppressive Agents; D003841:Deoxycytidine; D012264:Ribonucleotide Reductases; D000093542:Gemcitabine