Case ReportAcute Kidney Injury During Warfarin Therapy Associated With Obstructive Tubular Red Blood Cell Casts: A Report of 9 Cases
Section snippets
Case Reports
We searched the kidney biopsy files at the Department of Pathology, The Ohio State University Medical Center, Columbus, OH, for a 5-year period. We focused on biopsy specimens from patients who presented with unexplained AKI and hematuria while on warfarin therapy. We identified 2,801 native kidney biopsy specimens. Of these, 61 biopsy specimens were from patients on warfarin treatment (according to clinical information provided). AKI was noted in the clinical history for 35 biopsies. Only
Discussion
In the present study, we summarize pathological findings in kidney biopsy specimens obtained from patients on warfarin treatment who developed unexplained AKI. We identified RBCs in Bowman space, RBCs in tubules, and occlusive RBC casts predominantly in distal nephron segments. In addition, all patients had underlying chronic kidney injury, but no active proliferative glomerular lesions.
The association of hematuria with warfarin treatment in the absence of acute kidney disease has been reported
Acknowledgements
The authors thank Drs Stephen Silver, Ashutosh Singh, Ganesh Shidham, Paul Kovach, and John Panos for help in providing follow-up data.
This work was presented in part at the 2009 United States and Canadian Academy of Pathology Annual Meeting, March 7-13, 2009, Boston, MA.
Support: None.
Financial Disclosure: None.
References (14)
- et al.
Clinical significance of gross hematuria and its evaluation in patients receiving anticoagulant and aspirin treatment
Urology
(2000) - et al.
Thin basement membrane disease and acute renal failure secondary to gross hematuria and tubular necrosis
Am J Kidney Dis
(2000) - et al.
An unusual cause of gross hematuria and transient ARF in an SLE patient with warfarin coagulopathy
Am J Kidney Dis
(2004) - et al.
Loin pain-hematuria syndrome associated with thin glomerular basement membrane disease and hemorrhage into renal tubules
Kidney Int
(1996) - et al.
Proposed pathogenesis of idiopathic loin pain-hematuria syndrome
Am J Kidney Dis
(2006) - et al.
Haematuria and anticoagulants
Lancet
(1964) - et al.
Tamm-Horsfall glycoprotein: Biology and clinical relevance
Am J Kidney Dis
(2003)
Cited by (174)
KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease
2024, Kidney InternationalToxicology of chemical biocides: Anticoagulant rodenticides – Beyond hemostasis disturbance
2024, Comparative Biochemistry and Physiology Part - C: Toxicology and PharmacologyInvasive Treatment in Patients With Acute Myocardial Infarction and End-Stage Renal Disease: Does One Size Fits for All?
2023, American Journal of CardiologyClinical Outcomes in Patients With Biopsy Proven Anticoagulant-Related Nephropathy
2023, Kidney International ReportsCardiorenal Outcomes Among Patients With Atrial Fibrillation Treated With Oral Anticoagulants
2023, American Journal of Kidney DiseasesAnticoagulant-related nephropathy induced by direct-acting oral anticoagulants: Clinical characteristics, treatments and outcomes
2023, Thrombosis ResearchCitation Excerpt :Anticoagulant-related nephropathy (ARN) is a recently recognized form of acute kidney injury (AKI) with rapid deterioration of kidney function and even without any signs of coagulopathy and active bleeding in a patient taking anticoagulants [1,2]. As originally described in 2009 with a small case series of patients treated by warfarin [3], ARN has recently been recognized to be triggered by direct-acting oral anticoagulants (DOACs) accompanied by their increasing prescriptions. Since DOACs such as dabigatran may cause ARN in patients whether with normal or impaired kidney function which may lead to end stage renal disease (ESRD) [4], this novel nephropathy will gain increasing attentions.
Originally published online as doi:10.1053/j.ajkd.2009.04.024 on July 6, 2009.