The Effect of Renal Replacement Therapy in a Patient with Mercaptopurine Toxicity: Time to Revise Guidelines

H. J.L. Quaedvlieg*, F. N. Polderman, M. Borkent, De H.J.M. Jonge, P. A. Annema, L. J.J. Derijks, M. A. Sikma, C. Bethlehem

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Introduction: Mercaptopurine, a thiopurine, is used in various disorders of immune reg-ulation, such as autoimmune hepatitis. Thiopurine metabolism is complex with risk for overdosing, especially when metabolism is impaired by liver dysfunction. Hepatotoxicity may be due to mer-captopurine overdose and is often reversible after prompt cessation of the drug. Case Presentation: Treatment of thiopurine toxicity is mainly supportive and literature on en-hanced elimination by renal replacement therapy is ambiguous. Conclusion: In this case of thiopurine toxicity, a patient with autoimmune hepatitis presents with abdominal pain, nausea, vomiting, and diarrhea. We show in this case report that renal replacement therapy had no effect on total body clearance of mercaptopurine.

Original languageEnglish
Pages (from-to)299-302
Number of pages4
JournalCurrent Drug Safety
Volume19
Issue number2
DOIs
Publication statusPublished - 3 Feb 2024

Keywords

  • autoimmune hepatitis
  • concentrations
  • hepatotoxicity
  • Mercaptopurine toxicity
  • renal replacement therapy
  • thiopurine toxicity

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