Hemorrhagic Cystitis
Bleeding inflammation of the bladder urothelium — classically acrolein injury from the oxazaphosphorines (prevented by mesna), but also reported as immune-related, intravesical-chemical, or radiation-recall injury.
Where it strikes
Urine storage (outflow, not a nephron segment)
Agents’ overall severity
Each agent’s whole-drug severity grade, not the severity of this lesion specifically — an agent whose signature injury is elsewhere can still be graded severe here.
Agents’ onset window
How soon each agent’s kidney toxicity typically appears — a whole-drug tempo, not specific to this lesion.
Real-world reporting for this lesion
FAERS across all lesions →Agents with a disproportionate FAERS reporting signal for hemorrhagic cystitis (reporting odds ratio with a 95% CI lower bound above 1) — a spontaneous-reporting signal, not incidence or proven causation. FAERS carries reporting and indication biases and has no denominator.
Documented in the atlas profile and carrying a FAERS signal — the strongest claim the atlas makes.
Documented in a profile with no reporting signal. Mostly expected: naming this lesion on a report can require a biopsy, and silence is not evidence against the literature.
A real reporting signal that is not evidence for this drug-lesion pair: no MedDRA term names it, the naming subset asked alone came back flat, or the 2026-08 review attributed the reporting to the population, co-therapy, or class-level literature.
The terms that name this lesion are disproportionate, but no profile documents it for that agent. Most are echoed by a sibling agent in the same class. Leads for review, never lesions the atlas claims.
80 agents with a significant CYST reporting signal.
Management approach
Full framework →Prevent with mesna and hydration; this is an outflow (bladder) toxicity, not nephron injury.
Drug-level levers
- Hold further dosing for significant hemorrhagic cystitis.
- Co-administer mesna with ifosfamide and high-dose cyclophosphamide.
Pharmacologic toolkit
- Mesna — Binds acrolein in the urine; standard prophylaxis with the oxazaphosphorines.
- Hydration / bladder irrigation — Forced diuresis; continuous bladder irrigation for established hemorrhagic cystitis.
When to biopsy
Not a kidney-biopsy lesion; cystoscopy for severe or refractory bladder bleeding.
Monitoring
- · Urinalysis for hematuria
- · Symptoms of cystitis
Educational use only. Educational synthesis of the published literature — not a treatment protocol, dosing guide, or medical advice. Regimens and agents shown are illustrative of what the literature describes; verify against current guidelines (ASON / KDIGO / ASCO / NCCN) and individualize to the patient. Using this site creates no clinician–patient relationship.
Offending agents
Signature offenders
1Agents for which hemorrhagic cystitis is the defining renal lesion.