Many etiologies have resulted in thrombotic microangiopathy [TMA], amongst which are antineoplastic chemotherapies. Gemcitabine-related thrombotic microangiopathy [TMA] has rarely been described, but it is a life-threatening complication. However, only a few case reports have been conducted in Thailand. A 52-year-old male who was diagnosed with cholangiocarcinoma and was treated with surgery and gemcitabine. After that, he developed acute kidney injury,
generalized edema, and hemolytic anemia. The kidney biopsy revealed three renal pathologies in this patient that included
lupus nephritis class V, chronic thrombotic microangiopathy, and drug-induced acute interstitial nephritis. A review of the
medical record of the patient plus a comparison with the literature was conducted. The patient was treated with permanently stop gemcitabine, prednisolone, anti-hypertensive drugs and blood transfusion. His renal function and hemolytic anemia improved in one month later.

Keywords: Thrombotic microangiopathy, TMA, Gemcitabine