A Case Report of Acute Renal Failure and Fulminant Hepatitis Associated With Edaravone Administration in a Cerebral Infarction Patient

Abstract

A 60-year-old male with cerebral infarction was admitted to our hospital and treated with edaravone. On day 12 of hospitalization, he suddenly lost consciousness and went into shock. Based on the laboratory findings, acute renal failure (ARF), fulminant hepatitis, and disseminated intravascular coagulation (DIC) were diagnosed. We immediately initiated continuous hemodiafiltration for three days and performed three sessions of plasma exchange. Following this, a gradual improvement was observed in the patient's general condition and laboratory values. On day 17 of hospitalization, intermittent hemodialysis (HD) was initiated. On day 20 of hospitalization, his renal function started to improve with an increase in urine volume. HD was successfully discontinued on the same day. Although the drug lymphocyte stimulation test for edaravone was negative, edaravone-induced fulminant hepatitis was suggested based on liver biopsy findings. We present a case of ARF, fulminant hepatitis, and DIC due to edaravone administration that was successfully treated with blood purification techniques. Since the use of edaravone treatment is expected to increase in the future, it is essential that clinicians consider the potential adverse effects of this treatment. It is suggested that blood purification is effective in inducing remission in patients with complications due to edaravone treatment.

A Rare Presentation of Hepatitis A Infection with Extrahepatic Manifestations

“…Spontaneous resolution of acute kidney injury in interstitial nephritis has also been reported [14, 15]. Renal failure secondary to fulminant hepatitis improved in large doses of methylprednisolone, thus indicating an immune mediated reaction [16]. …”

The combined use of edaravone, diuretics, and nonsteroidal anti-inflammatory drugs caused acute kidney injury in an elderly patient with chronic kidney disease

“…Although edaravone and its metabolites are speculated to have toxic effects on the kidneys [7], the pathogenesis of edaravone-induced acute renal injury is currently unclear [7,8]. The mechanisms by which mannitol causes acute renal injury include dehydration, enhanced tubuloglomerular feedback, permeability damage, and renal vasoconstriction [15].…”

“…3). Clinical reports and animal experiments have shown that the use of edaravone, mannitol, or NSAIDs alone can cause acute renal failure [6][7][8][9][10][11][12]. Examination revealed that the patient received a score of nine on the Naranjo Adverse Drug Reaction Probability Scale [13], which indicated that the application of these drugs had a ''definite'' causal relationship with the acute kidney injury.…”

A critical assessment of edaravone acute ischemic stroke efficacy trials: is edaravone an effective neuroprotective therapy?

“…The major edaravone AE is reported to be an increased risk of renal toxicity associated [80, 81], which is reversible in 45% of patients after edaravone treatment is stopped [80]. However, 11 adverse side effects are now listed on the drug information sheet for the drug, including fulminant hepatitis[82], thrombocytopenia, rhabdomyolysis and acute lung injury. There is also a report of an increased frequency of hemorrhagic transformation when edaravone was administered to patients with cardiogenic embolism [83].…”