Abstract

FORTES, Pedro; ALVES, Filipa; SILVA, Cristina  and  PESSEGUEIRO, Pedro. Oral Anticoagulants-Related Nephropathy: An Entity to Remember. Medicina Interna [online]. 2019, vol.26, n.1, pp.52-59. ISSN 0872-671X.  https://doi.org/10.24950/rspmi/revisao/23/1/2019.

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

Keywords : Acute Kidney Injury/chemically induced; Administration, Oral; Anticoagulants/adverse effects; Warfarin/adverse effects.

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