Oral Anticoagulants-Related Nephropathy: An Entity to Remember
DOI:
https://doi.org/10.24950/rspmi/revisao/23/1/2019Keywords:
Acute Kidney Injury/chemically induced, Administration, Oral, Anticoagulants/adverse effects, Warfarin/adverse effectsAbstract
Oral anticoagulants-related nephropathy (ARN) is a new entity which has been essentially related to warfarin, although
the case definition has slight variations in different papers,
hindering strict epidemiological and clinical evaluations. Most
authors define this nephropathy as a form of acute kidney injury in the setting of an international normalized ratio (INR) ≥
3 (concerning warfarin therapy) and in the absence of other
etiologies of acute kidney injury. Chronic kidney disease, despite not essential to the development of ARN, is one of its
strongest risk factors. A kidney biopsy with glomerular hemorrhage, tubular obstruction with red blood cell casts and tubular epithelial cell lesion establishes the definitive diagnosis
in the appropriate clinical setting. Treatment is essentially supportive, aiming the correction of excessive anticoagulation.
However, renal function recovery is frequently incomplete. Recent studies emphasize new pathophysiological mechanisms,
other than those related to glomerular hemorrhage. Direct oral
anticoagulants have also recently been linked to ARN. Herein,
the authors review the literature about ARN and underline the
importance of this increasingly recognized but probably still
underdiagnosed entity, so as to improve close monitoring of
chronic kidney disease patients treated with oral anticoagulants.
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