CONTEXT: Hemolytic uremic syndrome is a rare condition compromising the clinical 
triad of acute renal failure, microangiopathic hemolytic anemia, and 
thrombocytopenia. Hemolytic uremic syndrome may be associated with a variety of 
etiologies, and chemotherapeutic agents have also been reported to be associated 
with hemolytic uremic syndrome, including mitomycin, cisplatin, bleomycin, and 
most recently gemcitabine.
CASE REPORT: A 72-year-old Caucasian male treated with four cycles of 
gemcitabine at 1,000 mg/m2 developed clinical and laboratory findings compatible 
with hemolytic uremic syndrome. He developed microangiopathic hemolysis, rapidly 
declining renal function with proteinuria and hematuria, and renal biopsy 
revealed thrombotic microangiopathy. Hemodialysis, plasmapheresis, and 
corticosteroid therapy were utilized but the process ultimately was 
irreversible.
CONCLUSION: With multiple reports of hemolytic uremic syndrome complicating 
gemcitabine therapy, it is imperative that clinicians heighten their awareness 
of this potentially lethal complication.