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Case Reports
. 2023 Sep 11;59(9):1645.
doi: 10.3390/medicina59091645.

Clinical Care Team's Guide for Awareness on Risk Assessment of Eltrombopag Complicating Acute Kidney Injury in Relapsed Immune Thrombocytopenic Patients: A Case Report

Eman Mostafa Hamed  1 , Mohamed Hussein Meabed  2 , Ahmed R N Ibrahim  3 , Ahmed M Khalaf  4 , Doaa Mohamed El Demerdash  5 , Marwa O Elgendy  1   6 , Haitham Saeed  7 , Tamer M Mahmoud  8 , Heba F Salem  9   10 , Hoda Rabea  7
Affiliations
Case Reports

Clinical Care Team's Guide for Awareness on Risk Assessment of Eltrombopag Complicating Acute Kidney Injury in Relapsed Immune Thrombocytopenic Patients: A Case Report

Eman Mostafa Hamed et al. Medicina (Kaunas). .

Abstract

Immune thrombocytopenia (ITP) is an autoimmune bleeding disorder caused by antigen-specific T cells and antiplatelet autoantibodies that inhibit platelet production in the bone marrow or destroy platelets in the spleen. ITP is a form of autoimmunity and is closely associated with inflammation. Corticosteroids are the first-line therapy for ITP, with a total response rate of 53-80%. However, corticosteroid therapy is associated with significant side effects and is often ineffective in patients with corticosteroid-resistant or -intolerant disease. Eltrombopag has been validated as a second-line option in ITP therapy. Despite several studies demonstrating the efficacy and safety of Eltrombopag in immune thrombocytopenia patients, the prevalence of Eltrombopag-induced acute kidney injury has been observed. This case report describes a patient who experienced acute kidney injury during Eltrombopag therapy. A sudden increase in serum creatinine to 6.7 mg/dL and metabolic acidosis occurred after eight weeks of Eltrombopag. The patient's renal failure had worsened, proteinuria was detected, and emergency hemodialysis was initiated. With vigilant kidney function screening and prompt treatment, the patient's renal function improved remarkably following cessation of Eltrombopag and initiation of hemodialysis. This case highlights the importance of comprehensive medication history-taking and vigilant kidney function screening in patients receiving Eltrombopag.

Keywords: Eltrombopag; acute kidney injury; autoimmune disease; corticosteroid resistance; drug induced; immune thrombocytopenia; relapsed.

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Conflict of interest statement

The final manuscript has been approved by all authors, and there are no conflicts of interest. The authors have no relevant affiliations or financial ties to any organization or entity that has a financial interest in or a financial conflict of interest with the subject matter or materials discussed in the manuscript. This includes employment, consulting, honoraria, stock ownership or options, expert testimony, received or pending grants or patents, and royalties.

Figures

Figure 1
Figure 1
The patient’s glomerular filtration rate and platelet count over time, with drug therapy (including Prednisolone (PSL), Rituximab (RTX), Eltrombopag (ELTRO), and Romiplostim (ROMP)), Eltrombopag discontinuation, and clinical management.
Figure 2
Figure 2
The serum creatinine level over time during Eltrombopag therapy and clinical management with hemodialysis and high dose of Methylprednisolone as shown.
See this image and copyright information in PMC

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