title: Kidney-limited thrombotic microangiopathy in patients with SLE treated with romiplostim.
abstract: We present the case of a 19 year-old Caucasian female with history of systemic lupus erythematosus (SLE) and normal baseline kidney function who developed severe acute renal failure following treatment of thrombocytopenia with the thrombopoietic agent romiplostim. Percutaneous kidney biopsy revealed thrombotic microangiopathy (TMA) without immune complex lupus glomerulonephritis. We discuss pathogenesis and differential diagnosis of TMA in patients with SLE and raise concerns regarding the use of thrombopoietic agents in such patients. Based on favorable long-term outcome in our case aggressive treatment and in particular prolonged use of plasma exchange in these patients are advocated.
authors.affiliation: Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: S
authors.initials: S
authors.lastname: Tomov
authors.forename: J
authors.initials: J
authors.lastname: Lazarchick
authors.forename: S E
authors.initials: SE
authors.lastname: Self
authors.forename: E T
authors.initials: ET
authors.lastname: Bruner
authors.forename: M N
authors.initials: MN
authors.lastname: Budisavljevic
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology*; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D010951:Plasma Exchange; D011247:Pregnancy; D011961:Receptors, Fc; D011993:Recombinant Fusion Proteins / Q000009:adverse effects*; D012720:Severity of Illness Index; D013921:Thrombocytopenia / Q000150:complications / Q000188:drug therapy; D013926:Thrombopoietin / Q000009:adverse effects*; D057049:Thrombotic Microangiopathies / Q000209:etiology* / Q000628:therapy; D055815:Young Adult
chemical_list: D011961:Receptors, Fc; D011993:Recombinant Fusion Proteins; D013926:Thrombopoietin; C488777:romiplostim