Abstract
We encountered a 14-year-old girl with AML (M3) in whom post-renal acute renal failure developed following complete bilateral urinary tract obstruction due to clot formation in the pelvis by aclarubicin (ACR). Macrohematuria was observed five days after the last day of ACR (30 mg/m2 × 3 days, div) administration. Five days later, she complained of anuria and bilateral abdominal pain. Complete obstructions of upper urinary tracts were confirmed by echogram. Two days later, clots flowed out and renal dysfunction improved immediately. However, ten hours later, anuria developed again and renal function got worse (UN : 92 mg/dl, Cre : 13.9 mg/dl). Four days later, clot flowed out again and renal dysfunction improved. As the right urinary tract obstruction still remained, a D-J catheter inserted into the pelvis and right hydronephrosis was relieved. ACR has a potent anti-leukemia effect with less cardiotoxicity than other anthracyclines. It has a unique adverse effect such as an injury of the urinary tract epithelium which is caused by its active metabolites. Some cases have been reported that dialytic treatment was inevitable due to urinary tract obstruction. In this case, a major cause of this disturbance seemed to be continuous 24 hr infusion of ACR, which allowed active metabolites of ACR to make contact with the urinary tract epithelium. Therefore, it is important to administer ACR during short periods with enough fluid to prevent urological hemorrhage.
