Kidney-limited thrombotic microangiopathy in patients with SLE treated with romiplostim

Lupus. 2013 Apr;22(5):504-9. doi: 10.1177/0961203313477900.


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.

Publication types

  • Case Reports

MeSH terms

  • Acute Kidney Injury / etiology*
  • Female
  • Humans
  • Lupus Erythematosus, Systemic / complications*
  • Plasma Exchange
  • Pregnancy
  • Receptors, Fc
  • Recombinant Fusion Proteins / adverse effects*
  • Severity of Illness Index
  • Thrombocytopenia / complications
  • Thrombocytopenia / drug therapy
  • Thrombopoietin / adverse effects*
  • Thrombotic Microangiopathies / etiology*
  • Thrombotic Microangiopathies / therapy
  • Young Adult


  • Receptors, Fc
  • Recombinant Fusion Proteins
  • Thrombopoietin
  • romiplostim