Abstract: SA-PO284
A Case of Rivaroxaban Associated Nephropathy
Session Information
- Trainee Case Reports - VI
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Krukowski, Adrian, Weiss Hospital, Chicago, Illinois, United States
- Gadapa, Sai prasad, University of Chicago, Chicago, Illinois, United States
- Gallan, Alexander James, The University of Chicago, Chicago, Illinois, United States
- Chang, Anthony, UChicago Medicine, Chicago, Illinois, United States
- Cunningham, Patrick, University of Chicago, Chicago, Illinois, United States
Introduction
The adverse effects of oral anticoagulants (ACs) are commonly related to bleeding, however, a less common complication described with warfarin is the development of AC nephropathy. Novel ACs are quickly replacing warfarin, as they do not require monitoring of INR. Because they have not been used as long, the scope of their adverse effects are still coming to light.
Case Description
A 55-year-old Caucasian man was referred to the Nephrology clinic for worsening renal function. His PMHx includes a nerve sheath sarcoma in his right arm treated with surgery, radiation, and ifosfamide 15 years prior, stable CKD-II, and a large unprovoked pulmonary embolism 3 years prior. There was no history of hypertension or diabetes. He was placed on rivaroxaban with the intention of lifelong anticoagulation. He had otherwise been active and well.
He denied hematuria, cloudy/frothy urine, nephrolithiasis, dysuria, edema, or dyspnea. Medications were rivaroxaban 20 mg daily, famotidine, and tramadol PRN. Social and family history was unremarkable. Physical exam revealed clear breath sounds and absent lower extremity edema.
On presentation, creatinine (Cr) was 1.6 mg/dL and GFR was 45 mL/min. Other lab testing was unremarkable. His previous baseline serum Cr was stable at 1.2-1.4 mg/dL until two months before referral. UA revealed 1+ blood, 1+ protein, 3-5 RBCs/HPF, and no casts. Spot protein/Cr ratio revealed a value of 0.18, compared to a single measurement of 1.2 a year prior. Renal US was normal.
Renal biopsy revealed eosinophilic granular intratubular casts with occasional RBCs, and mild acute tubular injury. Glomeruli showed congestion with RBCs and focal duplication of the glomerular basement membrane. Electron microscopy revealed multilayering of the peritubular capillary basement membranes but no other abnormalities. No immune complex-mediated disease was identified. Two months after biopsy serum creatinine is unchanged.
Discussion
There have been few published reports of nephropathy associated with novel ACs. As these drugs become more popular, it is possible that the incidence of associated nephropathy will increase. Extrapolating his decline in GFR suggests the patient could need renal replacement therapy in the next 10 years. Therefore, it is important to raise awareness that novel oral ACs such as rivaroxaban may be a cause of worsening kidney function.