Liver iron concentration and renal dysfunction in β-thalassemia: a case series and exploratory clinical observations

Renal complications are increasingly recognized among patients with β-thalassemia, particularly as survival improves with modern therapies. In this descriptive case series, we report five adult β-thalassemia patients who developed acute kidney injury (AKI) and were assessed for iron overload using MRI-based liver iron concentration (LIC). LIC values ranged from 2.5 to 26.1 mg/g dry weight. Three patients with LIC values above 7 mg/g progressed to chronic kidney disease (CKD), a pattern that may point to a possible relationship between higher LIC and adverse renal outcomes; however, given the very small number of patients, the absence of a comparison cohort, and the lack of direct assessment of renal iron deposition, this observation should be regarded as a preliminary clinical trend rather than a confirmed association or predictive relationship. Ferritin levels varied across patients and did not consistently align with renal function changes. Estimated glomerular filtration rate (eGFR), ranged from 5 to 21 mL/min/1.73 m² at the time of AKI, and all patients required hospitalization; three received dialysis. This series highlights the clinical variability of AKI presentation among thalassemia patients and underscores the need for further investigation into the potential role of iron burden in renal impairment. Larger, controlled studies incorporating direct measures of renal iron deposition and tubular injury biomarkers are needed before LIC monitoring could be considered for renal risk stratification in this population.