Kidney Res Clin Pract.  2014 Dec;33(4):174-180. 10.1016/j.krcp.2014.11.001.

Anticoagulants and acute kidney injury: clinical and pathology considerations

• Brodsky SV

• KMID: 2224257
• DOI: http://doi.org/10.1016/j.krcp.2014.11.001

Abstract

We have recently identified a new clinical syndrome in patients receiving warfarin for anticoagulation therapy. This syndrome has been named warfarin-related nephropathy (WRN), and patients with chronic kidney disease (CKD) appear to be particularly susceptible. WRN is defined as an acute increase in international normalized ratio (INR) to > 3.0, followed by evidence of acute kidney injury (AKI) within 1 week of the INR increase. AKI was defined as a sustained increase in serum creatinine of greater than or equal to 0.3 mg/dL. The AKI cannot be explained by any other factors, and the kidney biopsy demonstrates extensive glomerular hemorrhage with tubular obstruction by red blood cells (RBCs). Beyond AKI, WRN is a significant risk factor for mortality within the first 2 months of diagnosis and it accelerates the progression of CKD. We demonstrated that 5/6 nephrectomy in rats is a suitable experimental model to study WRN. Animals treated with warfarin showed an increase in serum creatinine and morphologic findings in the kidney similar to those in humans with WRN. Our recent evidence suggests that novel oral anticoagulants may induce AKI. Diagnosis of WRN may be challenging for a renal pathologist. A few cases with suspected WRN and pathologic considerations are described.

Keyword

Acute kidney injury; Anticoagulation therapy; Chronic kidney disease; Warfarin-related nephropathy

MeSH Terms

Acute Kidney Injury*
Animals
Anticoagulants*
Biopsy
Creatinine
Diagnosis
Erythrocytes
Hemorrhage
Humans
International Normalized Ratio
Kidney
Models, Theoretical
Mortality
Nephrectomy
Pathology*
Rats
Renal Insufficiency, Chronic
Risk Factors
Warfarin
Anticoagulants
Creatinine
Warfarin