Ronnier J. Aviles, MD; Stacey A. Vlahakis, MD; Peter L. Elkin, MD
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Aviles R., Vlahakis S., Elkin P.; Cyclophosphamide-Associated Uroepithelial Toxicity. Ann Intern Med. 1999;131:549. doi: 10.7326/0003-4819-131-7-199910050-00034
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Published: Ann Intern Med. 1999;131(7):549.
TO THE EDITOR:
The urologic complications of cyclophosphamide therapy often limit its use (1). We describe what we believe to be the first case in the literature of isolated upper urinary tract toxicity. This toxicity occurred after a cumulative oral cyclophosphamide 1.4 g, which is lower than any reported to date.
A 72-year-old woman with a 7-year history of Wegener granulomatosis presented with gross hematuria and dysuria of 1 week's duration. She received cyclophosphamide (1.4 g) over 2 weeks as treatment for relapse of the granulomatosis.
On admission, the patient appeared acutely ill but was hemodynamically stable. Urinalysis showed gross hematuria with no casts. Renal ultrasonography showed mild hydroureteronephrosis. Cystoscopy revealed normal bladder uroepithelium and bleeding from the right ureteral orifice. Retrograde ureteropyelography showed marked irregularity of the mucosa of the upper ureter, renal pelvis, and calyces (Figure). Renal and pelvic arteriography showed no evidence of pruning. On percutaneous nephroscopy, the uroepithelium was gray and necrotic, with dystrophic calcifications in the extracted fragments. The collecting system was thoroughly irrigated, and copious debris was removed. Subsequently, the gross hematuria resolved and renal function improved.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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