Abstract
Warfarin is associated with anticoagulant-related nephropathy (ARN), one of the potential side effects. This is evidenced by a progressively increasing number of detected cases of deterioration in the kidney function even in patients with normal baseline function (GFR {glomerular filtration rate}) in addition to the chronic kidney disease (CKD) patients who are already vulnerable to ARN. There has been a clinical correlation in a rapid decline of kidney function and international normalized ratio (INR) levels of greater than three. ARN is a significant but underdiagnosed complication of anticoagulation that is associated with increased renal morbidity and all-cause mortality. We want to emphasize the importance of monitoring kidney function regularly and adjusting the appropriate doses of warfarin. We present a case of a 57-year-old female who was on warfarin for the mechanical aortic valve, presented with acute kidney injury and supratherapeutic INR. Her renal biopsy showed diffuse mesangial proliferative glomerulonephritis.
Highlights
Warfarin-related nephropathy (WRN), referred to as anticoagulant-related nephropathy (ARN) is a type of acute kidney injury (AKI) that is caused by excessive anticoagulation with warfarin and other anticoagulants [1]
We present a case of a 57-year-old female who was on warfarin for the mechanical aortic valve, presented with acute kidney injury and supratherapeutic international normalized ratio (INR)
Warfarin has been related to anticoagulant-related nephropathy (ARN) as one of the potential side effects, with progressively increasing in the number of detected cases of deterioration in the kidney function in patients with normal baseline function in addition to the chronic kidney disease (CKD) patients who are already vulnerable to ARN [2,4,5]
Summary
Warfarin-related nephropathy (WRN), referred to as anticoagulant-related nephropathy (ARN) is a type of acute kidney injury (AKI) that is caused by excessive anticoagulation with warfarin and other anticoagulants [1]. Warfarin is the most appropriate anticoagulation regimen in those with prosthetic thrombosis, as most of the direct factor Xa inhibitors have not been studied enough for the prevention of thromboembolic events in patients with mechanical valve prosthesis, and excessive thrombotic complications owed to direct thrombin inhibitors [2]. Independent of the chronic kidney disease status, glomerular hemorrhage and renal tubular obstruction by red blood cells can be seen in patients who were treated with excessive warfarin. We report an interesting case of a 57-year-old female on warfarin for mechanical aortic valve who presented with AKI requiring hemodialysis and was found to have diffuse mesangial proliferative glomerulonephritis and warfarin-related nephropathy on renal biopsy. Kidney biopsy pathology under electron microscopy revealed diffuse mesangial proliferative glomerulonephritis with mild focal exudative features, immune complex type It showed red blood cell casts, multifocal, with diffuse acute tubular injury consistent with warfarin nephropathy. The patient was discharged to subacute rehabilitation for reconditioning and to continue with outpatient hemodialysis for a few more months
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