Keimyung Med J.  2014 Jun;33(1):83-88. 10.0000/kmj.2014.33.1.83.

A Case of Acute Kidney Injury Complicated During Therapy of Warfarin Anticoagulation after the Prosthetic Heart Valve Replacement

• Lee SH
• Yim TH
• Kim BC
• Kim HR
• Sung HJ
• Park KK
• Kim YM

• KMID: 2224207
• DOI: http://doi.org/10.0000/kmj.2014.33.1.83

Abstract

A 58-year-old male patient was admitted with the weakness feeling of right upper extremity. The patient, who had been done the replacement of prosthetic mitral and aortic valves 17 years ago, is taking a warfarin to prevent the systemic thromboembolism. On admission, laboratory tests revealed that the prothrombin time international normalized ratio (PT INR) was abnormal as 6.21, serum creatinine level increased to 10.46 mg/dL. The renal biopsy was performed to find the cause of Acute Kidney Injury (AKI). Biopsy Specimens showed the evidence of acute tubular injury and glomerular hemorrhage: red blood cells (RBCs) in Bowman space and numerous occlusive RBC casts in tubules. We experience a case of AKI as a result of the inappropriate warfarin monitoring, which is developed by the glomerular hemorrhage and renal tubular obstruction through RBC casts. We suggest that patients with warfarin therapy need to monitor the kidney function and blood coagulation indicators carefully.

Keyword

Acute kidney injury; Anticoagulants; Warfarin

MeSH Terms

Acute Kidney Injury*
Anticoagulants
Aortic Valve
Biopsy
Blood Coagulation
Creatinine
Erythrocytes
Heart Valves*
Heart*
Hemorrhage
Humans
International Normalized Ratio
Kidney
Male
Middle Aged
Prothrombin Time
Thromboembolism
Upper Extremity
Warfarin*
Anticoagulants
Creatinine
Warfarin