A definite causal link between pegylated liposomal doxorubicin (PLD) and renal-limited thrombotic microangiopathy (TMA) remains unestablished. Here, we report two cases of PLD-induced renal-limited TMA, one in a patient with myxofibrosarcoma and the other in a patient with liposarcoma. The two patients received a high cumulative dose of PLD, and both presented with a rise in serum creatinine and proteinuria. Kidney biopsy revealed TMA with chronic mesangiolysis and capillary wall double contouring. Neither patient had concomitant exposure to TMA-causing drugs, such as gemcitabine, anti-vascular endothelial growth factor agents, or mammalian target of rapamycin (mTOR) inhibitors. The workup for secondary causes of TMA was negative in both patients. The cessation of PLD therapy led to improvement or stabilization in serum creatinine and proteinuria in both patients. These two cases provide a clear causal link between PLD and renal-limited TMA. The high cumulative dose of PLD increases the risk of renal TMA. Early recognition of PLD-induced renal TMA can lead to timely cessation of PLD therapy and potentially preserve kidney function.
