Abstract: PUB456
A Woman with Anticoagulant-Related Nephropathy (ARN): Recently Recognized AKI Syndrome
Session Information
Category: Trainee Case Report
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Zahid, Hasan, Orange Park Medical Center, Orange Park, Florida, United States
- Abbas, Ramla, Orange Park Medical Center, Orange Park, Florida, United States
- Aftab, Ghulam Mustafa, Orange Park Medical Center, Orange Park, Florida, United States
- Kotihal, Ramesh M., Nephrology Associates of NE Florida, Orange Park, Florida, United States
Introduction
Anticoagulant related nephropathy (ARN) 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 with no other obvious etiology. We present a case of a 65 year old female who developed AKI secondary to warfarin therapy.
Case Description
A 65 year old female with past history of protein S deficiency, hypertension and CKD stage 3 presented with blood in urine. She was found to have oliguric AKI with a supratherapeutic INR of 7.8 and Creatinine of 14.1 mg/dl while on warfarin therapy for multiple deep venous thrombi in the past. Home medications included warfarin and lisinopril. Review of systems was otherwise negative with no recent contrast administration. Exam was significant only for hematuria. Coagulation profile showed PTT of 46.9 seconds and PT of 82.5 seconds. All other labs were within normal limits. Several RBCs with RBC casts were seen on urinalysis. Urine protein creatinine ratio was 0.9. Ultrasound disclosed echogenic kidneys with no hydronephrosis. All medications including warfarin were held immediately on admission and despite volume resuscitation, BUN and Cr did not show any improvement. After 5 days of hospitalization her INR improved from 7.8 to 2.6 and Cr came down to 4.17 mg/dl. Renal biopsy revealed severe occlusion of renal tubules by red blood cells and casts with tubular cell damage consistent with acute tubular necrosis proving warfarin induced renal injury.
Discussion
There is growing evidence that ARN is a potentially serious complication of anticoagulation therapy. In addition to warfarin, there are several recent case reports that ARN can develop in patients on dabigatran or on apixaban. The recent retrospective analysis of RE-LY shed light on it as well. The higher prescription volume of anticoagulants, with lack of data on treatment for ARN, calls for large prospective trials.