Nefropatia Associada aos Anticoagulantes Orais: Uma Entidade a Reconhecer

Autores

DOI:

https://doi.org/10.24950/rspmi/revisao/23/1/2019

Palavras-chave:

Administração Oral, Anticoagulantes/efeitos adversos, Lesão Renal Aguda/induzida quimicamente, Varfarina/efeitos adversos

Resumo

A nefropatia associada aos anticoagulantes orais (NAAO),
da qual o paradigma é a nefropatia associada à varfarina,
tem sido definida de modo variável na literatura, dificultando
avaliações epidemiológicas e clínicas rigorosas. A maior parte dos autores considera que a mesma se caracteriza pela
presença de lesão renal aguda coincidente com international
normalized ratio (INR) ≥3 (no caso da varfarina), requerendo
a exclusão de outras causas de lesão renal aguda e sendo
independente da presença de doença renal crónica prévia, a
qual constitui no entanto um importante factor de risco. A histologia fornece o diagnóstico definitivo num contexto clínico
apropriado, tendo como principais achados hemorragia glomerular, obstrução tubular por cilindros eritrocitários e lesão
das células epiteliais tubulares. O tratamento é de suporte,
englobando a reversão da coagulopatia mas a recuperação
da função renal é frequentemente incompleta. Estudos recentes apontam para a existência de mecanismos fisiopatológicos envolvidos na NAAO para além da hemorragia glomerular. Surgem também os primeiros relatos de caso de NAAO
associados à toma de anticoagulantes orais directos. O objectivo do presente trabalho é, centrando-nos na revisão da
literatura publicada sobre a NAAO, proceder a uma revisão
desta entidade, de modo a alertar para o provável subdiagnóstico da mesma e necessidade de melhor monitorização
do doente com doença renal crónica sob anticoagulação oral.

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Referências

Brodsky SV, Rovin BH, Hebert LA. Anticoagulant-related nephropathy. UpToDate. Waltham, 2016. [consultado 2017 Jan] Disponível em: https:// www.uptodate.com/contents/anticoagulant-related-nephropathy

Chang CC, Liou HH, Wu CL, Chang CB, Chang YJ, Chiu PF, et al. Warfarin slows deterioration of renal function in elderly patients with chronic kidney disease and atrial fibrillation. Clin Interv Aging. 2013;8:523-9. doi: 10.2147/ CIA.S44242.

Brodsky S. Anticoagulants and acute kidney injury: clinical and pathology considerations. Kidney Res Clin Pract. 2014; 33: 174-80. doi: 10.1016/j. krcp.2014.11.001.

Clase CM, Holden RM, Sood MM, Rigatto C, Moist LM, Thomson BK, et al. Should patients with advanced chronic kidney disease and atrial fibrillation receive chronic anticoagulation? Nephrol Dial Transplant. 2012; 27: 3719- 24. doi: 10.1093/ndt/gfs346.

Linthorst GE, Avis HJ, Levi M. Uremic thrombocytopathy is not about urea. J Am Soc Nephrol. 2010; 21: 753-5. doi: 10.1681/ASN.2009111181.

Chan KE, Lazarus JM, Thadhani R, Hakim RM. Warfarin use associates with increased risk for stroke in hemodialysis patients with atrial fibrillation. J Am Soc Nephrol. 2009; 20: 2223-33. doi: 10.1681/ASN.2009030319.

Kapoor KG, Bekaii-Saab T. Warfarin-induced allergic interstitial nephritis and leukocytoclastic vasculitis. Intern Med J. 2008; 38: 281-3. doi: 10.1111/j.1445-5994.2008.01646.x.

K/DOQI Workgroup. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis. 2005 45(4 Suppl 3): S1-153.

Herzog CA, Asinger RW, Berger AK, Charytan DM, Díez J, Hart RG, et al. Cardiovascular disease in chronic kidney disease. A clinical update from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2011; 80: 572-86. doi: 10.1038/ki.2011.223.

Shah M, Avgil-Tsadok M, Jackevicius CA, Essebag V, Eisenberg MJ, Rahme E, et al. Warfarin use and the risk for stroke and bleeding in patients with atrial fibrillation undergoing dialysis. Circulation. 2014; 129: 1196-203. doi: 10.1161/CIRCULATIONAHA.113.004777.

Yang F, Chou D, Schweitzer P, Hanon S. Warfarin in haemodialysis patients with atrial fibrillation: what benefit? Europace. 2010; 12: 1666-72. doi: 10.1093/europace/euq387

Chan KE, Lazarus JM, Thadhani R, Hakim RM. Anticoagulant and antiplatelet usage associated with mortality among hemodialysis patients. J Am Soc Nephrol. 2009; 20: 872-81. doi: 10.1681/ASN.2008080824.

Böhm M, Ezekowitz MD, Connolly SJ, Eikelboom JW, Hohnloser SH, Reilly PA et al. Changes in renal function in patients with atrial fibrillation – an analysis from the RE-LY Trial. J Am Coll Cardiol. 2015;65:2481-93. doi: 10.1016/j.jacc.2015.03.577.

Moll S, Huffman J. Cholesterol emboli associated with warfarin treatment. Am J Hematol. 2004; 77: 194-5. doi: 10.1002/ajh.20210.

Rivk DV, Warnock DG. Warfarin-related nephropathy: another newly recognized complication of an old drug. Kidney Int. 2011;80:131-3. doi: 10.1038/ ki.2011.85.

Sowers KM, Hayden MR. Calcific uremic arteriolopathy – Pathophysiology, reactive oxygen species and therapeutic approaches. Oxid Med Cell Longev. 2010;3:109-21. doi: 10.4161/oxim.3.2.11354.

Abdulhadi B, Mulki R, Giyal A, Rangaswami J. Novel oral anticoagulant and kidney injury: apixaban-related acute interstitial nephritis. BMJ Case Rep. 2017;2017. pii: bcr-2017-221641. doi: 10.1136/bcr-2017-221641.

Floege J, Eitner F. Current Therapy for IgA Nephropathy. J Am Soc Nephrol. 2011; 22: 1785-94. doi: 10.1681/ASN.2011030221.

Gallieni M, Fusaro M. Vitamin K and cardiovascular calcification in CKD: is patient supplementation on the horizon? Kidney Int. 2014; 86: 232-4.

Confraveux CB, Szulc P, Casey R, Boutroy S, Varennes A, Vilayphiou N, et al. Higher serum osteocalcin is associated with lower abdominal aortic calcification progression and longer 10-year survival in elderly men of the MINOS cohort. J Clin Endocrinol Metab. 2013; 98: 1084-92.

Oliveira M, Lima C, Góis M, Viana J, Carvalho F, Lemos S. Rivaroxaban-related nephropathy. Port J Nephrol Hypert. 2017; 31: 212-6.

Lim AK, Campbell DA. Haematuria and acute kidney injury in elderly patients admitted to hospital with supratherapeutic warfarin anticoagulation. Int Urol Nephrol. 2013; 45: 561-70. doi: 10.1007/s11255-012-0364-0.

Brodsky SV, Nadasdy T, Rovin BH, Satoskar AA, Nadasdy GM, Wu HM, et al. Warfarin-related nephropathy occurs in patients with and without chronic kidney disease and is associated with an increased mortality rate. Kidney Int. 2011; 80: 181-9. doi: 10.1038/ki.2011.44.

Ware K, Brodsky P, Satoskar AA, Nadasdy T, Nadasdy G, Wu H, et al. Warfarin-related nephropathy modeled by nephron reduction and excessive anticoagulation. J Am Soc Nephrol. 2011; 22: 1856-62. doi: 10.1681/ ASN.2010101110.

Di Maso V, Carraro M, Bevilacqua E, Bucconi S, Artero ML, Boscutti G. Warfarin-related nephropathy: possible role for the warfarin pharmacogenetic profile. Clin Kidney J. 2014;7: 605–8. . doi: 10.1093/ckj/sfu112.

Ware KM, Vance JC, Muni N, Hebert LA, Satoskar AA, Nadasdy G, et al. Oral warfarin and the thrombin inhibitor dabigatran increase blood pressure in rats: hidden danger of anticoagulant? Am J Hypertens. 2015; 28: 182-9. doi: 10.1093/ajh/hpu129.

Moeckel GW, Luciano RL, Brewster UC. Warfarin-related nephropathy in a patient with mild IgA nephropathy on dabigatran and aspirin. Clin Kidney J. 2013; 6: 507-9. doi: 10.1093/ckj/sft076.

Ryan M, Ware K, Wamri Z, Satoskar AA, Wu H, Nadasdy G, et al. Warfarin-related nephropathy is the tip of the iceberg: direct thrombin inhibitor dabigatran induces glomerular hemorrhage with acute kidney injury in rats. Nephrol Dial Transplant. 2014; 29:2228-34. doi: 10.1093/ndt/gft380.

Krishna VN, Warnock DG, Saxena N, Rizk DV. Oral anticoagulants and risk of nephropathy. Drug Saf. 2015; 38:527-33. doi: 10.1007/s40264-015-0290-z.

Brodsky SV, Satoskar A, Chen J, Nadasdy G, Eagen JW, Hamirani M, et al. Acute kidney injury during warfarin therapy associated with obstructive tubular red blood cell casts: a report of 9 cases. Am J Kidney Dis. 2009; 54: 1121-6. doi: 10.1053/j.ajkd.2009.04.024.

Brodsky S, Collins M, Park E, Rovin BH, Satoskar AA, Nadasdy G, et al. Warfarin therapy that results in an International Normalization Ratio above the therapeutic range is associated with accelerated progression of chronic kidney disease. Nephron Clin Pract. 2010; 115: 142-6. doi: 10.1159/000312877.

Pollack CV, Reilly PA, Eikelboom J, Glund S, Verhamme P, Bernstein RA, et al. Idarucizumab for dabigatran reversal. N Engl J Med. 2015; 373: 511-20. doi: 10.1056/NEJMoa1502000.

Chai-Adisaksopha C, Hillis C, Lim W, Boonywat K, Moffat K, Crowther M. Hemodialysis for the treatment of dabigatran-associated bleeding: a case report and systematic review. J Thromb Haemost.2015; 13: 1790-8. doi: 10.1111/jth.13117.

Ng CY, Tan CS, Chin CT, Lim SL, Zhu L, Woo KT,et al. Warfarin related nephropathy: a case report and review of the literature. BMC Nephrol. 2016; 17:15. doi: 10.1186/s12882-016-0228-4.

Ware K, Qamri Z, Ozcan A, Satoskar AA, Nadasdy G, Rovin BH, et al. N-acetylcysteine ameliorates acute kidney injury but not glomerular hemorrhage in an animal model of warfarin-related nephropathy. Am J Renal Physiol. 2013;304: F1421–7. doi: 10.1152/ajprenal.00689.2012.

Wheeler DS, Giugliano RP, Rangaswami J. Anticoagulation-related nephropathy. J Thromb Haemost. 2016; 14: 461–7. doi: 10.1111/jth.13229.

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Publicado

15-03-2019

Como Citar

1.
Fortes P, Alves F, Silva C, Pessegueiro P. Nefropatia Associada aos Anticoagulantes Orais: Uma Entidade a Reconhecer. RPMI [Internet]. 15 de Março de 2019 [citado 14 de Outubro de 2024];26(1):52-9. Disponível em: https://revista.spmi.pt/index.php/rpmi/article/view/369

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