Management of porphyria cutanea tarda in the setting of chronic renal failure: A case report and review

The treatment of porphyria cutanea tarda (PCT) in patients with chronic ren al failure poses a therapeutic challenge. In the absence of renal failure, phlebotomy and oral antimalarials have been the standard of care for PCT. H owever, in the presence of renal failure, associated chronic anemia often p recludes the use of phlebotomy, and oral antimalarials are usually ineffect ive. We describe a patient with severe symptomatic PCT and chronic renal fa ilure whose disease was successfully managed with a combination of high-dos e erythropoietin and small volume phlebotomy. We also review several previo usly reported approaches to management of PCT in the setting of renal failu re, which include small repeated phlebotomy, erythropoietin, deferoxamine, chloroquine, plasma exchange, high-efficiency/high-flux hemodialysis, chole styramine, charcoal hemoperfusion, and kidney transplantation. An algorithm for the management of these patients is proposed.