Anticoagulants and acute kidney injury clinical and pathology considerations.pdf.pdf

Kidney Res Clin Pract 33 (2014) 174–180
Kidney Research and Clinical Practice
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Review Article
Anticoagulants and acute kidney injury: clinical and pathology
considerations
Sergey V. Brodsky n
Department of Pathology, Ohio State University Wexner Medical Center, Columbus, OH, USA
Abstract
Article history: We have recently identified a new clinical syndrome in patients receiving warfarin
Received 2 November 2014 for anticoagulation therapy. This syndrome has been named warfarin-related
Accepted 7 November 2014
Available online 18 November 2014 nephropathy (WRN), and patients with chronic kidney disease (CKD) appear to be
particularly susceptible. WRN is defined as an acute increase in international
Keywords:
normalized ratio (INR) to , followed by evidence of acute kidney injury (AKI)
Acute kidney injury
fi
Anticoagulation therapy within 1 week of the INR increase. AKI was de ned as a sustained increase in serum
Chronic kidney disease creatinine of greater than or equal to mg/dL. The AKI cannot be explained by any
Warfarin-related nephropathy other factors, and the kidney biopsy demonstrates extensive glomerular hemor-
rhage with tubular obstruction by red blood cells (RBCs). Beyond AKI, WRN is a
significant risk factor for mortality within the first 2 months of diagnosis and it
accel