A case report of thrombotic microangiopathy in a patient with advanced pancreatic carcinoma: an emerging, rare, and serious complication

Sharon Kandari; Arshdeep Singh; Rohit Puri; Anil Cheriyan; Sandeep Kaur

doi:10.18203/2349-3933.ijam20251081

Authors

Sharon Kandari Department of Nephrology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
Arshdeep Singh Department of Nephrology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
Rohit Puri Department of Nephrology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
Anil Cheriyan Senior Resident, Department of Nephrology, AIIMS Rishikesh, India
Sandeep Kaur Department of Nephrology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20251081

Keywords:

Thrombotic microangiopathy, Gemcitabine induced-TMA, Acute kidney disease, Plasmapheresis, Chemotherapy-associated complication

Abstract

Thrombotic microangiopathies are characterized by microangiopathic hemolytic anemia and end-organ damage following endothelial injury. The chemotherapeutic agents used in malignancy are one of the important causes of secondary TMA. Both malignancy and TMA are associated with significant morbidity and mortality. Timely recognition of both can result in early target-specific treatment initiation and better outcomes for both diseases. Here, we present a case of TMA in a patient with stage 4 pancreatic carcinoma being treated with Gemcitabine presented with acute kidney disease with new-onset hypertension, edematous illness, and anemia. The patient was Hemodialysis dependent and was treated with steroids, plasma exchange, and rituximab. The patient remained HD dependent 6 months post-treatment and was declared ESRD. Highlighting the importance of early recognition and timely treatment initiation.

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