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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Clin+Kidney+J
2017 ; 10
(3
): 381-388
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Warfarin-related nephropathy induced by three different vitamin K antagonists:
analysis of 13 biopsy-proven cases
#MMPMID28616216
Golbin L
; Vigneau C
; Touchard G
; Thervet E
; Halimi JM
; Sawadogo T
; Lagoutte N
; Siohan P
; Zagdoun E
; Hertig A
; Rioux-Leclercq N
; Frouget T
Clin Kidney J
2017[Jun]; 10
(3
): 381-388
PMID28616216
show ga
Background: Acute kidney injury (AKI) with renal tubular obstruction by red blood
cell casts (RBCC) has been described in patients treated with warfarin and is
known as warfarin-related nephropathy (WRN). Methods: To determine whether other
vitamin K antagonists (VKA) cause WRN, we retrospectively collected and analyzed
the clinical and histological data of 13 patients treated with different VKA
(seven with fluindione, four with warfarin and two with acenocoumarol) in seven
French hospitals. Results: They all developed gross hematuria following
overanticoagulation complicated by severe AKI (median serum creatinine
concentration?=?693??mol/L). Histological analysis of the kidney biopsies
highlighted the presence of intratubular RBCC and acute tubular necrosis in all
patients and of an underlying kidney disease in 12 patients. WRN was suspected in
patients treated with warfarin; however, the initial diagnosis was incorrect in
six of the nine patients treated with other VKA. Nine patients progressed to
chronic kidney disease, one fully recovered renal function, two died and one
still needs dialysis. Conclusions: This is the first report of AKI caused by
fluindione. In agreement with the recent publication on AKI in two patients
treated with dabigatran, we suggest that the term 'anticoagulant-related
nephropathy' is more appropriate than WRN. Gross hematuria in patients with an
underlying kidney disease and treated with VKA requires rapid control of the
international normalized ratio and renal function monitoring.