{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T10:52:50Z","timestamp":1785322370311,"version":"3.55.0"},"reference-count":46,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,9,11]],"date-time":"2023-09-11T00:00:00Z","timestamp":1694390400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007446","name":"King Khalid University","doi-asserted-by":"publisher","award":["RGP2\/145\/44"],"award-info":[{"award-number":["RGP2\/145\/44"]}],"id":[{"id":"10.13039\/501100007446","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>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\u201380%. 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\u2019s renal failure had worsened, proteinuria was detected, and emergency hemodialysis was initiated. With vigilant kidney function screening and prompt treatment, the patient\u2019s 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.<\/jats:p>","DOI":"10.3390\/medicina59091645","type":"journal-article","created":{"date-parts":[[2023,9,12]],"date-time":"2023-09-12T04:38:48Z","timestamp":1694493528000},"page":"1645","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Clinical Care Team\u2019s Guide for Awareness on Risk Assessment of Eltrombopag Complicating Acute Kidney Injury in Relapsed Immune Thrombocytopenic Patients: A Case Report"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9443-7841","authenticated-orcid":false,"given":"Eman Mostafa","family":"Hamed","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacy, Faculty of Pharmacy, Nahda University (NUB), Beni-Suef 62521, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Hussein","family":"Meabed","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Hematology, Faculty of Medicine, Beni-Suef University, Beni-Suef 62521, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed R. N.","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha 61421, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed M.","family":"Khalaf","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Clinical Hematology, Beni-Suef University, Beni-Suef 62521, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5061-9536","authenticated-orcid":false,"given":"Doaa Mohamed","family":"El Demerdash","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Clinical Hematology, Faculty of Medicine, Cairo University, Giza 54212, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5466-0552","authenticated-orcid":false,"given":"Marwa O.","family":"Elgendy","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, Faculty of Pharmacy, Nahda University (NUB), Beni-Suef 62521, Egypt"},{"name":"Department of Clinical Pharmacy, Faculty of Medicine, Beni-Suef University Hospitals, Beni-Suef University, Beni-Suef 62521, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haitham","family":"Saeed","sequence":"additional","affiliation":[{"name":"Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62521, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamer M.","family":"Mahmoud","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Faculty of Medicine, Beni-Suef University, Beni-Suef 62521, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heba F.","family":"Salem","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62521, Egypt"},{"name":"Pharmaceutics and Industrial Pharmacy Department, 6 October Technological University, Giza 62521, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hoda","family":"Rabea","sequence":"additional","affiliation":[{"name":"Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62521, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1038\/s41572-021-00284-z","article-title":"Acute kidney injury","volume":"7","author":"Kellum","year":"2021","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1016\/j.cvsm.2016.06.011","article-title":"Kidney disease and the nexus of chronic kidney disease and acute kidney injury: The role of novel biomarkers as early and accurate diagnostics","volume":"46","author":"Yerramilli","year":"2016","journal-title":"Vet. Clin. Small Anim. Pract."},{"key":"ref_3","first-page":"4385","article-title":"Serum uric acid and inflammation in patients with immune thrombocytopenic purpura: Preliminary results","volume":"19","author":"Dal","year":"2015","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1182\/blood-2008-06-162750","article-title":"Both primitive and definitive blood cells are derived from Flk-1+ mesoderm","volume":"113","author":"Lugus","year":"2009","journal-title":"Blood"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"6152","DOI":"10.4049\/jimmunol.168.12.6152","article-title":"Down-regulation of monocyte apoptosis by phagocytosis of platelets: Involvement of a caspase-9, caspase-3, and heat shock protein 70-dependent pathway","volume":"168","author":"Lang","year":"2002","journal-title":"J. Immunol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"653","DOI":"10.2147\/JBM.S259101","article-title":"Management of adult patients with Immune Thrombocytopenia (ITP): A review on current guidance and experience from clinical practice","volume":"12","author":"Song","year":"2021","journal-title":"J. Blood Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e29447","DOI":"10.1002\/pbc.29447","article-title":"Thrombopoietin receptor agonists and rituximab for treatment of pediatric immune thrombocytopenia: A systematic review and meta-analysis of prospective clinical trials","volume":"69","author":"Ayad","year":"2021","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1097\/MOH.0000000000000612","article-title":"An update on the pathophysiology of immune thrombocytopenia","volume":"27","author":"Semple","year":"2020","journal-title":"Curr. Opin. Hematol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2040620719837906","DOI":"10.1177\/2040620719837906","article-title":"Switching thrombopoietin receptor agonist treatments in patients with primary immune thrombocytopenia","volume":"10","author":"Godeau","year":"2019","journal-title":"Ther. Adv. Hematol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2386","DOI":"10.1182\/blood-2008-07-162503","article-title":"Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: Report from an international working group","volume":"113","author":"Rodeghiero","year":"2009","journal-title":"Blood"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1097\/BOR.0000000000000599","article-title":"Treatment of primary and secondary immune thrombocytopenia","volume":"31","author":"Kado","year":"2019","journal-title":"Curr. Opin. Rheumatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1182\/bloodadvances.2021005627","article-title":"Cost-effectiveness of Eltrombopag vs intravenous immunoglobulin for the perioperative management of immune thrombocytopenia","volume":"6","author":"Kaur","year":"2022","journal-title":"Blood Adv."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3780","DOI":"10.1182\/bloodadvances.2019000812","article-title":"Updated international consensus report on the investigation and management of primary immune thrombocytopenia","volume":"3","author":"Provan","year":"2019","journal-title":"Blood Adv."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Hamed, E.M., Ibrahim, A.R., Meabed, M.H., Khalaf, A.M., El Demerdash, D.M., Elgendy, M.O., Saeed, H., Salem, H.F., and Rabea, H. (2023). Therapeutic Outcomes of High Dose-Dexamethasone versus Prednisolone+ Azathioprine, Rituximab, Eltrombopag, and Romiplostim Strategies in Persistent, Chronic, Refractory, and Relapsed Immune Thrombocytopenia Patients. Pharmaceuticals, 16.","DOI":"10.3390\/ph16091215"},{"key":"ref_15","first-page":"26","article-title":"Treatment lines of childhood chronic ITP: A retrospective single-center analysis","volume":"19","author":"Yasser","year":"2020","journal-title":"\u0412o\u043f\u0440o\u0441\u044b \u0433\u0435\u043c\u0430\u0442o\u043bo\u0433\u0438\u0438\/o\u043d\u043ao\u043bo\u0433\u0438\u0438 \u0438 \u0438\u043c\u043c\u0443\u043do\u043f\u0430\u0442o\u043bo\u0433\u0438\u0438 \u0432 \u043f\u0435\u0434\u0438\u0430\u0442\u0440\u0438\u0438"},{"key":"ref_16","first-page":"1547","article-title":"How I treat refractory immune thrombocytopenia","volume":"128","author":"Cuker","year":"2016","journal-title":"Blood J. Am. Soc. Hematol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1016\/j.hoc.2009.09.001","article-title":"Thrombopoietin and Platelet Production in Chronic Immune Thrombocytopenia","volume":"23","author":"Kuter","year":"2009","journal-title":"Hematol. Clin. N. Am."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1002\/ajh.21789","article-title":"Acute renal failure in a patient with antiphospholipid syndrome and immune thrombocytopenic purpura treated with Eltrombopag","volume":"85","author":"Sperati","year":"2010","journal-title":"Am. J. Hematol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Hamed, E.M., Ibrahim, A.R.N., Meabed, M.H., Khalaf, A.M., El Demerdash, D.M., Elgendy, M.O., Saeed, H., Salem, H.F., and Rabea, H. (2023). The Outcomes and Adverse Drug Patterns of Immunomodulators and Thrombopoietin Receptor Agonists in Primary Immune Thrombocytopenia Egyptian Patients with Hemorrhage Comorbidity. Pharmaceuticals, 16.","DOI":"10.3390\/ph16060868"},{"key":"ref_20","first-page":"240","article-title":"Real-world experience of Eltrombopag in immune thrombocytopenia","volume":"10","author":"Mishra","year":"2020","journal-title":"Am. J. Blood Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"66","DOI":"10.3389\/fmed.2020.00066","article-title":"Use of Eltrombopag in children with chronic immune thrombocytopenia (ITP): A real life retrospective multicenter experience of the Italian Association of Pediatric Hematology and Oncology (AIEOP)","volume":"7","author":"Giordano","year":"2020","journal-title":"Front. Med."},{"key":"ref_22","first-page":"e17478","article-title":"Severe Portal Vein Thrombosis During Eltrombopag Treatment Concomitant Splenectomy for Immune Thrombocytopenia","volume":"13","author":"Saito","year":"2021","journal-title":"Cureus"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2611","DOI":"10.12998\/wjcc.v9.i11.2611","article-title":"Eltrombopag-related renal vein thromboembolism in a patient with immune thrombocytopenia: A case report","volume":"9","author":"Wu","year":"2021","journal-title":"World J. Clin. Cases"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1592\/phco.31.6.622","article-title":"Focal segmental glomerulosclerosis with acute renal failure associated with Eltrombopag therapy","volume":"31","author":"Teng","year":"2011","journal-title":"Pharmacother. J. Hum. Pharmacol. Drug Ther."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e241462","DOI":"10.1136\/bcr-2020-241462","article-title":"Acute kidney injury and nephrotic syndrome associated with Eltrombopag therapy in chronic idiopathic thrombocytopenic purpura","volume":"14","author":"Ghosh","year":"2021","journal-title":"BMJ Case Rep."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3829","DOI":"10.1182\/bloodadvances.2019000966","article-title":"American Society of Hematology 2019 guidelines for immune thrombocytopenia","volume":"3","author":"Neunert","year":"2019","journal-title":"Blood Adv."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1080\/08923973.2021.1953063","article-title":"A systematic review on efficacy, safety, and treatment-durability of low-dose rituximab for the treatment of Pemphigus: Special focus on COVID-19 pandemic concerns","volume":"43","author":"Tavakolpour","year":"2021","journal-title":"Immunopharmacol. Immunotoxicol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1182\/blood.2019001617","article-title":"Eltrombopag for immune thrombocytopenia secondary to chronic lymphoproliferative disorders: A phase 2 multicenter study","volume":"134","author":"Visco","year":"2019","journal-title":"Blood"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1111\/bjh.16161","article-title":"Treatment efficacy for adult persistent immune thrombocytopenia: A systematic review and network meta-analysis","volume":"188","author":"Puavilai","year":"2019","journal-title":"Br. J. Haematol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1007\/s00467-015-3106-6","article-title":"Corticosteroids for the initial episode of steroid-sensitive nephrotic syndrome","volume":"30","author":"Hodson","year":"2015","journal-title":"Pediatr. Nephrol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1093\/ndt\/gfaa372","article-title":"Clinical features of acute kidney injury in patients receiving dabrafenib and trametinib","volume":"37","author":"Seethapathy","year":"2022","journal-title":"Nephrol. Dial. Transpl."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1159\/000501315","article-title":"Loop diuretics in acute kidney injury prevention, therapy, and risk stratification","volume":"44","author":"Patschan","year":"2019","journal-title":"Kidney Blood Press. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e33","DOI":"10.3324\/haematol.2011.048819","article-title":"The European Medicines Agency review of Eltrombopag (Revolade) for the treatment of adult chronic immune (idiopathic) thrombocytopenic purpura: Summary of the scientific assessment of the Committee for Medicinal Products for Human Use","volume":"96","author":"Nieto","year":"2011","journal-title":"Haematologica"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1634\/stemcells.2008-0366","article-title":"Preclinical activity of Eltrombopag (SB-497115), an oral, nonpeptide thrombopoietin receptor agonist","volume":"27","author":"Delorme","year":"2009","journal-title":"Stem Cells"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1159\/000285844","article-title":"Effects of TGF-\u03b2 on podocyte growth and disease progression in proliferative podocytopathies","volume":"33","author":"Lee","year":"2010","journal-title":"Kidney Blood Press. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1182\/bloodadvances.2017010660","article-title":"Eltrombopag for use in children with immune thrombocytopenia","volume":"2","author":"Kim","year":"2018","journal-title":"Blood Adv."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/1479-5876-4-9","article-title":"The thrombopoietin receptor, c-Mpl, is a selective surface marker for human hematopoietic stem cells","volume":"4","author":"Ninos","year":"2006","journal-title":"J. Transl. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1046\/j.1365-2141.1999.01429.x","article-title":"Human dendritic cells express the thrombopoietin receptor, c-Mpl","volume":"105","author":"Kumamoto","year":"1999","journal-title":"Br. J. Haematol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"461","DOI":"10.3109\/15563650.2013.811588","article-title":"Misuse of the Naranjo adverse drug reaction probability scale in toxicology","volume":"51","author":"Seger","year":"2013","journal-title":"Clin. Toxicol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"19","DOI":"10.5045\/br.2015.50.1.19","article-title":"Efficacy and safety of Eltrombopag in adult refractory immune thrombocytopenia","volume":"50","author":"Kim","year":"2015","journal-title":"Blood Res."},{"key":"ref_41","first-page":"e9902","article-title":"Romiplostim and Eltrombopag in immune thrombocytopenia as a second-line treatment","volume":"12","author":"Bidika","year":"2020","journal-title":"Cureus"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1007\/s40265-016-0581-4","article-title":"Eltrombopag: A review in paediatric chronic immune thrombocytopenia","volume":"76","author":"Burness","year":"2016","journal-title":"Drugs"},{"key":"ref_43","unstructured":"European Medicines Agency (2023, September 01). Revolade (Eltrombopag), Product Information. Available online: https:\/\/www.ema.europa.eu\/ema\/index.jsp?curl=pages\/medicines\/human\/medicines\/001110\/human_med_001322.jsp&mid=WC0b01ac058001d124."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1177\/0091270010372106","article-title":"Effect of hepatic or renal impairment on Eltrombopag pharmacokinetics","volume":"51","author":"Bauman","year":"2011","journal-title":"J. Clin. Pharmacol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"567","DOI":"10.2165\/00003495-200969050-00005","article-title":"Eltrombopag","volume":"69","author":"Keam","year":"2009","journal-title":"Drugs"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.2165\/11207390-000000000-00000","article-title":"Eltrombopag: A review of its use in treatment-refractory chronic primary immune thrombocytopenia","volume":"71","year":"2011","journal-title":"Drugs"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/9\/1645\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:49:02Z","timestamp":1760129342000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/9\/1645"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,11]]},"references-count":46,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["medicina59091645"],"URL":"https:\/\/doi.org\/10.3390\/medicina59091645","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,11]]}}}