[Mytomycin C nephrotoxicity. 3 new cases and review of the literature].

Three women with adenocarcinoma of cardia, adenocarcinoma of liver or ileum carcinoid tumor, respectively, were treated with mitomycin C (MMC) and 5-fluoro-uracil (5-FU). Two patients had renal impairment 6 and 11 months, the third as early as 8 weeks after initiation of MMC therapy. In the three cases, blood transfusions appeared to play an aggravating role inducing respiratory distress, microangiopathic hemolytic anemia and thrombocytopenia, and to accelerate progression of renal failure. Death occurred in the first patient; terminal renal insufficiency necessitated hemodialysis treatment in the second, and after 10 plasma exchanges, renal failure remained stable in the third. Light and electron microscopy study of the kidney revealed renal lesions compatible with thrombotic microangiopathy in all cases. Mesangiolysis with swollen nuclei of endothelial cells in most glomeruli was also seen in two cases. We compared our observations with the findings found in 30 previously reported cases. These observations substantiate the renal toxicity of mitomycin C.