CEN Case Reports

, Volume 7, Issue 2, pp 217–220 | Cite as

Gemcitabine-induced thrombotic microangiopathy with nephrotic syndrome

  • Daisuke Katagiri
  • Fumihiko HinoshitaEmail author
Case Report


We encountered a case of gemcitabine (GEM)-induced secondary thrombotic microangiopathy (TMA) with nephrotic syndrome. Advanced pancreatic cancer with liver metastasis had originally been diagnosed. Renal biopsy showed focal reduplication of the glomerular basement membrane, endothelial cell swelling, and narrowed capillary lumens with fragmented erythrocytes and fibrin deposition, compatible with TMA. Regular monitoring of renal function during GEM treatment and discontinuation of treatment if acute kidney injury (AKI) might occur is crucial, because AKI combined with TMA is life-threatening.


Thrombotic microangiopathy Gemcitabine AKI Nephrotic syndrome 



We wish to thank Dr. Makoto Tokuhara from the Department of Surgery at the National Center for Global Health and Medicine, Tokyo, Japan, for referring the patient, and Dr. Makoto Mochizuki from the Department of Pathology at Teikyo University Hospital, Tokyo, Japan for his advice regarding the pathology. This study was partly supported by overseas research fellowships (to D.K) from Uehara Memorial Foundation and 46th KANAE grants (to D.K) from the KANAE Foundation for the Promotion of Medical Science.

Compliance with ethical standards

Conflict of interest

Authors have declared that no conflict of interest exists for this work.

Ethical statement

All of the treatment and the examination followed the guideline laid down in the Declaration of Helsinki.

Informed consent

Informed consent for the treatment and the renal biopsy was obtained from the patient.


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Copyright information

© Japanese Society of Nephrology 2018

Authors and Affiliations

  1. 1.Division of Nephrology and HypertensionVanderbilt University Medical CenterNashvilleUSA
  2. 2.Department of NephrologyNational Center for Global Health and MedicineTokyoJapan

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