Anticoagulation-related nephropathy (ARN) is a significant and underdiagnosed complication in patients who receive anticoagulation therapy. It is characterized by acute kidney injury in the setting of excessive anticoagulation defined as an international normalized ratio > 3.0 in patients treated with warfarin. A definitive diagnosis is made by renal biopsy showing acute tubular necrosis with obstruction of the tubuli by red blood cell casts. However, the evidence shows that ARN can occur during treatment with novel oral anticoagulants as well. Although it has been suggested that antiplatelet therapy, such as aspirin, might contribute to coagulopathy (and therefore the hypothetical risk of ARN), there are no reports of ARN induced by antiplatelet therapy according to our knowledge. It is also reported that glomerular lesions (i.e., kidney disease) represent a risk factor for ARN. We present a case of an 82-year-old man who developed biopsy-proven ARN after the administration of dual antiplatelet therapy with no previous anticoagulation treatment and normal coagulation tests.

1st Department of Medicine 3rd Faculty of Medicine Charles University Prague Czech Republic

Clinical and Transplant Pathology Department Institute for Clinical and Experimental Medicine Prague Czech Republic

Zobrazit více v PubMed

Wheeler DS, Giugliano RP, Rangaswami J. Anticoagulation-related nephropathy. J Thromb Haemost. 2016 Mar;14((3)):461–7. PubMed

Ryan M, Ware K, Qamri Z, Satoskar A, 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 Dec;29((12)):2228–34. PubMed

Narasimha Krishna V, Warnock DG, Saxena N, Rizk DV. Oral anticoagulants and risk of nephropathy. Drug Saf. 2015 Jun;38((6)):527–33. PubMed

Kabir A, Nadasdy T, Nadasdy G, Hebert LA. An unusual cause of gross hematuria and transient ARF in an SLE patient with warfarin coagulopathy. Am J Kidney Dis. 2004 Apr;43((4)):757–60. PubMed

Kincaid-Smith P, Bennett WM, Dowling JP, Ryan GB. Acute renal failure and tubular necrosis associated with hematuria due to glomerulonephritis. Clin Nephrol. 1983 Apr;19((4)):206–10. PubMed

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 Jul;80((2)):181–9. PubMed PMC

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 Dec;54((6)):1121–6. PubMed

An JN, Ahn SY, Yoon CH, Youn TJ, Han MK, Kim S, et al. The occurrence of warfarin-related nephropathy and effects on renal and patient outcomes in korean patients. PLoS One. 2013;8((4)):e57661. PubMed PMC

Ozcan A, Ware K, Calomeni E, Nadasdy T, Forbes R, Satoskar AA, et al. 5/6 nephrectomy as a validated rat model mimicking human warfarin-related nephropathy. Am J Nephrol. 2012;35((4)):356–64. PubMed PMC

Rizk DV, Warnock DG. Warfarin-related nephropathy: another newly recognized complication of an old drug. Kidney Int. 2011 Jul;80((2)):131–3. PubMed

Brodsky SV, Hebert LA. Anticoagulant-Related Nephropathy: Is an AKI Elephant Hiding in Plain View? J Am Coll Cardiol. 2016 Nov;68((21)):2284–6. PubMed

Angiolillo DJ. Variability in responsiveness to oral antiplatelet therapy. Am J Cardiol. 2009 Feb;103((3 Suppl)):27A–34A. PubMed