A 60-year-old patient, with no morbid history, who in an abdominal computed tomography performed for abdominal pain, was found to have a 2 cm carcinoma located in the head of the pancreas.
He underwent a Whipple procedure.
There were 2 regional lymph nodes with metastases from carcinoma and no distant dissemination.
Three months after surgery, chemotherapy with GEM was initiated.
After receiving 11 doses of EMG, 4 months after starting treatment and having received a total cumulative dose of 16,400 mg (9,318 mg/m2), the patient developed edema/ brachial edema and ankle110 hypertension.
Laboratory tests showed hematuria (26-50 minutes creatinine per field), proteinuria (1,740 mg/24 h), granulose cylindruria, rise in serum creatinine up to a maximum of 21 mg/dL clearance at a dose of 2173 m2.
Before this, progressive anemia (hemoglobin 6.0 g/dL) and thrombocytopenia (20,000 mm3) were observed, which were attributed to myelodepression by GEM.
Total bilirubin increased to 1.79 mg/dL, direct bilirubin to 0.93 mg/dL and LDH to 701 U/L (VN: 125-243) secondary to liver toxicity, which was interpreted as
The administration of new doses of GEM was suspended, furosemi-de was prescribed to control edema and olmesartan for the management of hypertension.
Since the platelet count was above 100,000 mm3, a percutaneous renal biopsy showed characteristic findings of active chronic thrombotic microangiopathy.
The optical coherence tomography revealed the presence of glomeruli with numerous double contours in their capillary loops and arterioles, with intense decrease in their lumen, concentric hyperplasia of endocells and incorporated deposits
Immunofluorescence examination did not show presence of glomeruli complexes.
Elevated electrocardiograms confirmed glomerular filtration defects; specifically, the presence of multiple double contours with cellular interposition and marked expansion of the rare internal lamina of the basement membrane by reference material.
All these alterations were found in the absence of complex dense deposits.
The pedicelar lesion was moderate.
GEM discontinuation was accompanied by improvement in renal function and laboratory parameters.
In the last control, 10 weeks after the last dose of EMG, hemoglobin was 12.3 g/dL, platelets 147,000 mm3, leukocytes 4,700 mm3, serum creatinine 1.18 mg/dL, normal creatinine clearance 85 ml.
The patient continued to receive olmesartan as an antihypertensive therapy due to renal damage caused by EMG.
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