Nefropatia Associada aos Anticoagulantes Orais: Uma Entidade a Reconhecer
DOI:
https://doi.org/10.24950/rspmi/revisao/23/1/2019Palavras-chave:
Administração Oral, Anticoagulantes/efeitos adversos, Lesão Renal Aguda/induzida quimicamente, Varfarina/efeitos adversosResumo
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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