The Injury Atlas
CYST

Hemorrhagic Cystitis

Acrolein injury to the bladder urothelium — an outflow toxicity of the oxazaphosphorines, prevented by mesna.

3agents

Where it strikes

Bladder / Urothelium

Urine storage (outflow, not a nephron segment)

See it on the nephron

Severity mix

Severe· 1Mild· 2

Reversibility

Often irreversible· 1Reversible· 2

Signature offenders

1

Agents for which hemorrhagic cystitis is the defining renal lesion.

ThiotepaEarly HC during/after conditioning; later HC with viral (BK/JC) reactivation.Hemorrhagic cystitis is a recognized complication of alkylator-based conditioning; thiotepa-containing (thiotepa-busulfan-fludarabine) regimens are associated with higher HC risk, with overall post-transplant HC reported in roughly the 12-37% range across regimens and confounded by viral reactivation.Mild

Also associated

2

Agents that cause hemorrhagic cystitis as a secondary pattern alongside a different signature lesion.

IfosfamideAcute tubulopathy during therapy; chronic Fanconi/CKD can emerge months–years later.Subclinical proximal tubulopathy is near-universal; overt Fanconi ~5% (range 1.4–30%), higher in young children.SevereCyclophosphamideHyponatremia within hours; cystitis acute.Dose-related hyponatremia (not reliably quantified); hemorrhagic cystitis ~5–20%, lower with mesna prophylaxis.Mild
See these on the Toxic-Ties graphAll 14 lesions