ELTROMBOPAG: A RARE CAUSE OF ACUTE INTERSTITAL NEPHRITIS
Recommended Citation
Rajanayagam J, Huang T, Elshayeb M, Reddy S. ELTROMBOPAG: A RARE CAUSE OF ACUTE INTERSTITAL NEPHRITIS. Am J Kidney Dis 2025; 85(4):2.
Document Type
Conference Proceeding
Publication Date
4-1-2025
Publication Title
Am J Kidney Dis
Abstract
Acute interstitial nephritis (AIN) commonly causes acute kidney injury (AKI) and accounts for 15–27% of renal biopsies performed. AIN occurs when there is inflammatory damage to the renal parenchyma caused by T-cell stimulation, medication-induced tubular damage and/or antibody mediated cellular injury. The known causes of AIN include antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), immune checkpoint inhibitors, and infections. However, this case will highlight Eltrombopag, a thrombopoietin receptor agonist, as a potential inciting factor of AIN. 70 year-old female with recent biopsy-proven aplastic anemia on cyclosporine, hypertension and pancytopenia presented with acute kidney injury (AKI) with a serum creatinine (SCr) 2.89mg/dL increased from baseline SCr 0.4-0.7mg/dL. Urinalysis showed 1+ blood and no albuminuria. Kidney ultrasound showed no hydronephrosis. AKI was unresponsive to volume repletion and progressively worsened. Serologic tests including C3/C4, CPK, LDH, haptoglobin, Anti-GBM, ANA, Anti double-stranded DNA, MPO/PR-3, anti-histone Ab, Anti-SCL–70, cryoglobulins were negative. Upon further review, Eltrombopag was initiated for refractory thrombocytopenia after which she developed a morbilliform rash of the trunk and extremities. Although she received other medications including cyclosporine, ciprofloxacin, anti-thymocyte globulin, and oxcarbazepine, the type and temporal relationship to rash onset is not commonly associated with these medications. Since kidney biopsy was not safe due to thrombocytopenia, it was reasonably assumed function returned to baseline within 8 days and the rash also resolved. Majority of AIN cases are commonly attributed to NSAIDs, antibiotics, and checkpoint inhibitors. This case is unique since Eltrombopag is not often associated with AIN. The temporal relationship between the AKI and rash along with the morbilliform drug eruption made Eltrombopag the probable cause of AIN. The prompt improvement in both the rash and renal function with discontinuation of Eltrom additionally supports Eltrombopag as the inciting agent for AIN.
Volume
85
Issue
4
First Page
2
