Cisplatin-associated hemolytic uremic syndrome.

BACKGROUND: Hemolytic uremic syndrome (HUS) is an acquired disorder largely affecting infants and young children. It is characterized by the triad of microangiopathic hemolytic anemia, acute renal failure, and thrombocytopenia. Although its etiology is unknown, viral and bacterial infections, disseminated malignancies in adults, and a variety of chemotherapeutic agents including cisplatin, have been implicated in its occurrence. The association of HUS with chemotherapeutic agents after its detection in a pediatric patient treated with cisplatin is reviewed.

METHODS: A 16-year-old male with osteosarcoma was treated with cisplatin as part of a chemotherapy protocol. After the fourth course, his renal function deteriorated and necessitated cessation of cisplatin. Nine months after the initiation of cisplatin, HUS developed. There was no evidence of residual tumor or metastatic disease. He received numerous packed erythrocyte and platelet transfusions for persistent hemolysis and underwent several episodes of hemodialysis. Utilizing this patient as an example, the authors reviewed the incidence of HUS developing subsequent to the use of other chemotherapeutic agents.

RESULTS: In the publishing literature, chemotherapy-associated HUS has been described to occur 54 days to 14 months after the initiation of chemotherapeutic regimens. A variety of agents was associated with the phenomenon.

CONCLUSION: Hemolytic uremic syndrome may be a complication of cisplatin, as evidenced by the condition that occurred in a 16-year-old patient with osteosarcoma after cisplatin therapy.