losartan-potassium and Porphyria-Cutanea-Tarda

Topics: Anemia, Sickle Cell; Biopsy; Complementary Therapies; Diagnosis, Differential; Erythropoietin; Hemochromatosis; Hepatitis C, Chronic; Humans; Iron; Kidney Transplantation; Liver; Metabolic Syndrome; Phlebotomy; Polycythemia; Polycythemia Vera; Porphyria Cutanea Tarda; Postoperative Complications

Porphyria cutanea tarda (PCT) is the most common type of porphyria. There is an association of PCT with haemochromatosis, diabetes mellitus and hepatitis C infection. The basis of treatment of PCT consists of three elements: avoidance of triggering factors, iron depletion and porphyrin elimination. Alcohol and certain systemic medical drugs, such as oestrogens (or tuberculostatics), should be considered as triggering factors, and as far as possible, avoided. Other triggering factors, such as chronic haemodialysis in renal insufficiency, need a different approach. The hallmark in iron depletion is phlebotomy. Porphyrin elimination is achieved using low-dose chloroquin therapy. The treatment is safe and effective but has its limits in cases with haemochromatosis (HFE) gene mutations. Here iron depletion needs additional phlebotomy. In patients with chronic haemodialysis-associated PCT, chloroquine is ineffective. Erythropoietin, desferroxamine and small-volume phlebotomy have been employed to control the disease. Childhood PCT is very rare. No controlled studies are available, but published experience suggests that body weight-adapted chloroquine therapy or small volume phlebotomy might be useful.

Topics: Chloroquine; Deferoxamine; Erythropoietin; Humans; Iron; Phlebotomy; Porphyria Cutanea Tarda; Renal Dialysis; Sunscreening Agents

The treatment of porphyria cutanea tarda (PCT) in patients with chronic renal failure poses a therapeutic challenge. In the absence of renal failure, phlebotomy and oral antimalarials have been the standard of care for PCT. However, in the presence of renal failure, associated chronic anemia often precludes the use of phlebotomy, and oral antimalarials are usually ineffective. We describe a patient with severe symptomatic PCT and chronic renal failure whose disease was successfully managed with a combination of high-dose erythropoietin and small volume phlebotomy. We also review several previously reported approaches to management of PCT in the setting of renal failure, which include small repeated phlebotomy, erythropoietin, deferoxamine, chloroquine, plasma exchange, high-efficiency/high-flux hemodialysis, cholestyramine, charcoal hemoperfusion, and kidney transplantation. An algorithm for the management of these patients is proposed.

Topics: Adult; Algorithms; Erythropoietin; Female; Humans; Iron Overload; Kidney Failure, Chronic; Phlebotomy; Porphyria Cutanea Tarda; Renal Dialysis

Topics: Diagnosis, Differential; Dose-Response Relationship, Drug; Erythropoietin; Female; Hepacivirus; Hepatitis C Antibodies; Hepatitis C, Chronic; Humans; Kidney Failure, Chronic; Middle Aged; Phlebotomy; Porphyria Cutanea Tarda; Renal Dialysis

Topics: Aged; Aged, 80 and over; Diagnosis, Differential; Epoetin Alfa; Erythropoietin; Humans; Male; Porphyria Cutanea Tarda; Recombinant Proteins

Porphyria cutanea tarda is treated with phlebotomies in the absence of renal failure. However, in patients on maintenance hemodialysis, this will lead to the need for high doses of erythropoietin. We describe the case of a 63-year-old hemodialysis patient who had chronic hepatitis C virus and developed porphyria cutanea tarda after iron overload due to repeated transfusions. She was treated with erythropoietin and phlebotomies reaching clinical remission 4 months after beginning treatment.

Topics: Erythropoietin; Female; Hepacivirus; Hepatitis C, Chronic; Humans; Iron Overload; Kidney Failure, Chronic; Middle Aged; Porphyria Cutanea Tarda; Renal Dialysis

The diagnosis and management of porphyria cutanea tarda (PCT) is complicated when it occurs in the context of renal failure, chronic hemodialysis, and anemia. We report a case of a woman who presented with painful acral blisters and hyperpigmentation. Her medical history included systemic lupus erythematosus, chronic hepatitis C infection, and renal failure necessitating chronic hemodialysis with a baseline anemia. A highly elevated serum porphyrin level led to the diagnosis of PCT. Treatment with small repeated phlebotomies and concomitant administration of erythropoietin was effective in managing her PCT.

Topics: Adult; Erythropoietin; Female; Follow-Up Studies; Hepatitis C, Chronic; Humans; Kidney Failure, Chronic; Lupus Erythematosus, Systemic; Phlebotomy; Porphyria Cutanea Tarda; Renal Dialysis; Risk Assessment

Topics: Deferoxamine; Erythropoietin; Female; Humans; Middle Aged; Porphyria Cutanea Tarda; Recombinant Proteins; Renal Dialysis

Topics: Adult; Erythropoietin; Humans; Kidney Failure, Chronic; Male; Porphyria Cutanea Tarda

Pseudoporphyria cutanea tarda occurred in two children undergoing peritoneal dialysis and receiving erythropoietin therapy. The mechanism whereby erythropoietin might lead to photosensitization is unknown, but physicians should be aware of this possible association.

Topics: Child; Erythropoietin; Female; Humans; Male; Peritoneal Dialysis; Photosensitivity Disorders; Porphyria Cutanea Tarda