Recurrent Hemolytic Uremic Syndrome and Metastatic Malignancy

Abstract

A 64-year-old patient with a prostatic adenocarcinoma presented two well-documented episodes of hemolytic-uremic syndrome (HUS) occurring 8 months apart and resolving without renal sequelae. The temporal relationship between these episodes and the natural progression of the underlying disease as well as the absence of chemotherapy favor the hypothesis of cancer-associated HUS. The clinical, laboratory and pathological findings of this patient and 3 additional patients reported in the literature are discussed. These cases suggest that malignancy should be suspected in adults developing the HUS and that this form of HUS need not have a poor prognosis despite progressive cancer.

Hemolytic Uremic Syndrome in Prostatic Carcinoma

“…Six cases of HUS in previously untreated adenocarcinoma of the prostate have been reported and are summarized in table 1 [3][4][5][6][7]. Comparing the 6 published cases with our patient reveals some similarities.…”

“…The patient developed oliguric renal failure and needed dialysis for 13 days. Hormonal treatment with diethylstilbestrol (DES) was started Renal biopsy 5 Number of plasmaphereses 6 Days of dialysis treatment 7 Recovery of renal function 8 Time between diagnosis of HUS and diagnosis of bone metastases. 4 Duration of follow-up since diagnosis of first HUS episode.…”

“…4 Duration of follow-up since diagnosis of first HUS episode. 5 Renal biopsy performed and showing features of HUS. 6 Number of plasmaphereses performed during initial/subsequent relapses of HUS (case in reference 6 was treated with plasma infusion alone).…”

“…Rarely, HUS occurred prior to any systemic treatment. We describe a case of adenocarcinoma of the prostate with an exceptionally long survival of over 7 years after HUS, and compare it to the 6 published cases of HUS in untreated prostate cancer [3][4][5][6][7].…”

Hemolytic Uremic Syndrome Associated with Immunoglobulin A Nephropathy: A Case Report and Review of Cases of Hemolytic Uremic Syndrome with Glomerular Disease.

“…Onthe other hand, secondary HUS is rare and is generally limited to adults. It is almost always associated with various conditions such as pregnancy (1), collagen disease (2), severe hypertension (3), cancer (4), or the use of certain drugs (5,6). But among those conditions, HUS associated with glomerular disease has rarely been reported and the relation between glomerular disease and HUShas been unknown.…”