Erythropoietin-induced hypertensive urgency in a patient with chronic renal insufficiency: case report and review of the literature.
Hypertension is a potentially dangerous side effect of erythropoietin treatment; however, extreme elevations in blood pressure are rare. A 75-year-old woman with chronic renal insufficiency was treated with subcutaneous erythropoietin. Three weeks before she started receiving erythropoietin, her hematocrit was 27.2%; after 5 weeks of treatment, it rose to 45.7%. The patient came to the emergency department and was admitted with hypertensive urgency. During her hospital stay she was treated with nitroglycerin and nitroprusside infusions, extended-release nifedipine, a variety of beta-blockers, clonidine, and furosemide. By day 3, her blood pressure was adequately controlled. Her renal insufficiency may have progressed as a result of the hypertensive episode, which probably was related to erythropoietin administration and the resultant rapid increase in her hematocrit. Erythropoietin dosing should be titrated to increase the hematocrit gradually, and blood pressure should be monitored closely to avoid serious side effects such as hypertensive emergencies.
Novak
Barbara L
BL
Department of Family Medicine, Idaho State University, Pocatello, Idaho 83209, USA.
Force
Rex W
RW
Mumford
Brett T
BT
Solbrig
Ronald M
RM
D000368:Aged; D004638:Emergency Treatment; D004921:Erythropoietin / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000139:chemically induced* / Q000188:drug therapy; D007279:Injections, Subcutaneous; D007676:Kidney Failure, Chronic / Q000188:drug therapy*
D004921:Erythropoietin