Anticoagulant-related nephropathy in a patient with IgA nephropathy

Góis, Mário; Azevedo, Ariana; Carvalho, Fernanda; Nolasco, Fernando

doi:10.1136/bcr-2016-218748

Cited by 12 publications

(4 citation statements)

References 17 publications

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“…Even a moderate increase in INR has been shown to aggravate macroscopic hematuria in patients with IgAN leading to AKI [7]. Recently, it has been shown that ARN is not only observed in patients with warfarin but also in those receiving DOAC [8][9][10][11][12]. In our patient, the coagulopathy could be potentiated by the underlying liver cirrhosis in addition to dabigatran.…”

Section: Discussionmentioning

confidence: 66%

Dabigatran causing severe acute kidney injury in a patient with liver cirrhosis

Cheung

2019

CEN Case Rep

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Anticoagulant-related nephropathy (ARN), a significant but frequently undiagnosed problem in patients receiving anticoagulation, is found to be associated with increased renal morbidity and all-cause mortality. While ARN is mainly associated with warfarin use, recent case reports suggest that it may also occur in patients taking direct oral anticoagulants (DOAC). We report a patient who had a history of alcoholic liver cirrhosis and paroxysmal atrial fibrillation, and received dabigatran 110 mg twice daily for 1 year. He presented with gross hematuria and severe acute kidney injury with an international normalized ratio of 4.09. Dabigatran was stopped and he was put on temporary hemodialysis support. His renal function gradually improved when the hematuria subsided. Renal biopsy later confirmed the presence of red blood cell casts inside the renal tubules with features of IgA nephropathy. Finally, his renal function returned back to baseline level. As DOAC has been increasingly used nowadays for the treatment of various thromboembolic diatheses, regular monitoring of renal function is warranted, especially in patients with underlying glomerular diseases and coagulopathy such as chronic liver diseases.

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Section: Discussionmentioning

confidence: 66%

Dabigatran causing severe acute kidney injury in a patient with liver cirrhosis

Cheung

2019

CEN Case Rep

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“…So far, the known risk factors for ARN are pre-existing CKD, advanced age, body weight, diabetic nephropathy, arterial hypertension, glomerulonephritis and heart failure (6,10,11). The main preventive measure is the adjustment of anticoagulant dose, particularly in CKD patients.…”

Section: Discussionmentioning

confidence: 99%

Case report: rivaroxaban related nephropathy

et al. 2022

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The characteristics of direct oral anticoagulants (DOACs) make them more appealing for prevention of thromboembolic events than vitamin K antagonists (VKA). Despite that, both classes have been a recognized as a cause of anticoagulant related nephropathy (ARN). Herein we describe a case of a 72-year-old man, with chronic kidney disease (CKD), medicated with rivaroxaban, who presented with acute kidney injury (AKI) and microscopic hematuria. The kidney biopsy revealed anticoagulant related-nephropathy. Rivaroxaban was suspended, the patient showed improvement of renal function and apixaban was prescribed. This case emphasizes the need for careful monitoring of serum creatinine when these drugs are prescribed, especially in high risk groups.

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“…To our knowledge, only 4 cases of ARN in patients with IgA nephropathy have been reported, of which 2 patients were treated with dabigatran, 3 one patient was treated with acenocoumarol, 6 and only one patient was treated with warfarin. 7 IgA nephropathy leads to glomerular hemorrhage and macroscopic hematuria through RBC accumulation within the glomerulus and casts that can occlude the tubules. Subsequent events including interstitial hemorrhage and oxidative stress on the kidney lead to the overall progression of ARN.…”

Section: Discussionmentioning

confidence: 99%

My Bleeding Nephrons!

Padala

Hinnant

et al. 2019

Journal of Investigative Medicine High Impact Case Reports

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Anticoagulation-related nephropathy (ARN) is an uncommon diagnosis that should be considered in patients presenting with unexplained acute kidney injury (AKI) and coagulopathy. In this article, we present the case of a 70-year-old male with a history of cirrhosis and portal vein thrombosis on Coumadin who presented to the hospital with gross hematuria. The patient was diagnosed with AKI on chronic kidney disease (CKD) secondary to ARN superimposed on sclerosing IgA nephropathy. ARN, also known as warfarin-associated nephropathy, is an uncommon condition in which AKI from glomerular hemorrhage develops in a patient with an international normalized ratio greater than 3. The most common risk factor for development of ARN is CKD. AKI in our patient unearthed preexisting CKD due to IgA nephropathy as evidenced by the biopsy.

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Anticoagulant-related nephropathy in a patient with IgA nephropathy

Cited by 12 publications

References 17 publications

Dabigatran causing severe acute kidney injury in a patient with liver cirrhosis

Dabigatran causing severe acute kidney injury in a patient with liver cirrhosis

Case report: rivaroxaban related nephropathy

My Bleeding Nephrons!

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