Erythropoietin-induced hypertensive encephalopathy in a child: Possible mechanisms

Recombinant human erythropoietin (r-HuEPO) is a powerful therapy for the anemia of renal insufficiency and renal failure patients. Hypertension is a commonly observed side effect of this therapy in the pediatric and adult populations. However, hypertensive encephalopathy is a rare occurrence, and only a few cases have been reported in the pediatric literature. The exact mechanism of the r-HuEPO-induced hypertension and encephalopathy remains elusive. We describe a 14-year-old South Asian male with renal failure secondary to Alport's syndrome who developed hypertensive encephalopathy after 2 months of r-HuEPO therapy. Our case demonstrates the temporal association with regard to r-HuEPO contributing to encephalopathy. We also review the literature, summarizing the possible mechanisms of rHuEPO-related hypertension.