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

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.

Acute renal thrombotic microangiopathy caused by eltrombopag and romiplostim in a patient with myelodysplastic syndromes (MDS) and underlying antiphospholipid syndrome

“…Sperati et al describe acute renal failure from eltrombopag in a patient with preexisting APS [ 3 ] ; Garra et al mention two other cases of catastrophic antiphospholipid syndrome in lupus patients treated with eltrombopag [ 10 ] . Three others noted that the patients had tested negative for aPL antibodies [ 8 , 9 , 11 ] . Tomov describes a 19-year-old girl with acute kidney injury after romiplostim use for lupus-associated ITP, who underwent a kidney biopsy that revealed thrombotic microangiopathy [ 11 ] .…”

“…She tested negative for aPL. The other two reports [ 7 , 8 ] did not mention testing the patients for aPL. Two of these patients had significant proteinuria and nephrotic syndrome with the use of eltrombopag [ 12 , 13 ] .…”