Anticoagulant-Related Nephropathy in a Patient on Coumadin

Abstract

Abstract Introduction/Objective Anticoagulant therapy is commonly used to prevent stroke and systemic embolism in patients with atrial fibrillation. However, it carries the risk of bleeding and can lead to serious complications such as anticoagulant-related nephropathy (ARN), a recently described entity characterized by hematuria and acute kidney injury. This report presents a case of a 79-year-old male with a history a patient with a history of atrial fibrillation on coumadin, highlighting the importance of monitoring for anticoagulant-related complications and the need for prompt diagnosis and management to prevent further renal damage. Methods/Case Report The kidney biopsy showed evidence of underlying hypertensive and diabetic nephropathy, with nodular and global glomerulosclerosis, moderate to marked interstitial fibrosis, and tubular atrophy along with many red cell casts of variable ages in the tubules indicative of anticoagulant-related nephropathy. Additionally, one glomerulus had a partial cellular crescent associated with a focus of blood clot, likely related to heavy hematuria. Patient is seronegative for ANCA. The immunofluorescence microscopy is non-contributory due to absence of glomerulus in the sample. Electron microscopy showed diffuse foot process effacement and microvillous transformation of podocytes, increased mesangial matrix, and thickened glomerular basement membranes, but no immune complex deposits. these ultrastructural features confirm the background diabetic nephropathy. Results (if a Case Study enter NA) NA Conclusion Anticoagulant-related nephropathy (ARN) is a rare but serious complication of anticoagulation therapy that can result in hematuria and acute kidney injury. Our case highlights the importance of monitoring for anticoagulant-related complications, especially in high-risk patients with multiple comorbidities. Prompt diagnosis and management of ARN is essential to prevent further renal damage. In this case, despite initial improvement with vitamin K therapy, the patient developed severe renal dysfunction requiring dialysis and renal biopsy. This emphasizes the need for increased awareness and early recognition of ARN in patients on anticoagulant therapy.