Presentation of Pulmonary Hypertension Treated with Sotatercept

Abstract

Pulmonary hypertension (PH) is a complex, progressive disease often leading to acute kidney injury (AKI), right heart failure (RHF), and multi-organ dysfunction. This case involves a 64-year-old woman with severe pulmonary arterial hypertension who required intensive care after repeated episodes of AKI and RHF. The case explores the interconnected pathophysiology of reduced renal perfusion, ascites-induced intra-abdominal hypertension, and venous congestion. Management included continuous renal replacement therapy (CRRT), non-invasive ventilation (NIV) to avoid hemodynamic compromise, and later conventional dialysis for volume overload and worsening renal function. Oxygen therapy was carefully titrated due to significant right-to-left shunting through a patent foramen ovale (PFO). After conventional treatments failed, she was started on Sotatercept, a novel therapy targeting pulmonary vascular remodeling.