Abstract
Introduction
There is a scarcity of data on anticoagulation-related nephropathy (ARN) caused by
direct-acting oral anticoagulants (DOACs) in recent years.
Materials and methods
We collected literatures on DOACs-induced ARN to October 1, 2022, without language
restrictions for retrospective analysis.
Results
Twenty events were included with a median onset time of 28 days among which fourteen
were caused by dabigatran. Patients accompanied by chronic kidney disease (85 %) seemed
more easily to have an ARN. Clinical symptoms associated with ARN were mostly presented
as hematuria and acute decline of renal function (100 %), then abnormal coagulation
function (75 %) but only one with an INR over 3. Renal biopsies were performed in
14 patients, with thirteen showing occlusive intratubular red blood cell casts and
ten showing acute tubular injury of varying intensity or even tubular necrosis. Extensive
changes in interstitial compartment like hemorrhage, fibrosis or inflammation were
also presented in eight biopsies. IgA nephropathy as a latent or undiagnosed disease
was demonstrated in eight biopsies. Treatments of ARN were mainly supportive with
all patients discontinuing DOACs and 35 % initiating dialysis for acute deterioration
of renal function. Steroids were used in 9 patients with a severe ARN verified by
biopsy. 60 % of patients did not recover baseline renal function and some even deteriorated.
Conclusions
In conclusion, DOACs-induced ARN is a rare but serious adverse reaction. A prompt
diagnosis of ARN and supportive treatments are necessary for patients receiving DOACs
concurrent with an acute renal injury.
Keywords
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References
- Anticoagulation-related nephropathy: the most common diagnosis you've never heard of.Am. J. Med. 2019; 132: e631-e633
- Anticoagulation-related nephropathy.J. Thromb. Haemost. 2016; 14: 461-467
- Acute kidney injury during warfarin therapy associated with obstructive tubular red blood cell casts: a report of 9 cases.Am. J. Kidney Dis. 2009; 54: 1121-1126
- 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; 29: 2228-2234
- Warfarin-related nephropathy occurs in patients with and without chronic kidney disease and is associated with an increased mortality rate.Kidney Int. 2011; 80: 181-189
- Efficacy and safety of apixaban compared with warfarin in patients with atrial fibrillation in relation to renal function over time: insights from the ARISTOTLE randomized clinical trial.JAMA Cardiol. 2016; 1: 451-460
- Acute kidney injury aggravated by treatment initiation with apixaban: another twist of anticoagulant-related nephropathy.Kidney Res. Clin. Pract. 2017; 36: 387-392
- Warfarin-related nephropathy in a patient with mild IgA nephropathy on dabigatran and aspirin.Clin. Kidney J. 2013; 6: 507-509
- Idarucizumab for the treatment of dabigatran-related nephropathy.Clin. Kidney J. 2021; 14: 710-711
- Dabigatran-induced nephropathy and its successful treatment with idarucizumab - case report and literature review.Thromb. Res. 2018; 169: 120-122
- Dabigatran causing severe acute kidney injury in a patient with liver cirrhosis.. 2019; 8: 125-127
- Anticoagulant related nephropathy induced by dabigatran.. 2018; 2018: 7381505
- Acute kidney injury due to anticoagulant-related nephropathy : a suggestion for therapy.Case Rep. Nephrol. 2020; 2020: 8952670
- Acute kidney injury and undiagnosed immunoglobulin a nephropathy after dabigatran therapy.Proc. (Bayl. Univ. Med. Cent.). 2018; 31: 321-323
- Rivaroxaban-related acute kidney injury in a patient with IgA vasculitis.BMJ Case Rep. 2019; 12e227756
- Rivaroxaban-related nephropathy.Portuguese Journal of Nephrology & Hypertension. 2017; 31: 212-216
- Anticoagulant-related nephropathy: a case report and review of the literature of an increasingly recognized entity.Int. Urol. Nephrol. 2017; 49: 1401-1407
- Dabigatran-induced anticoagulant-related nephropathy with undiagnosed IgA nephropathy in a patient with normal baseline renal function.CEN Case Rep. 2019; 8: 292-296
- Anticoagulant-related nephropathy to edoxaban.Clin. Nephrol. 2021; 96: 360-362
- Dabigatran-related nephropathy in a patient with undiagnosed IgA nephropathy.Case Rep. Nephrol. 2015; 2015298261
- Simultaneous subacute interstitial nephritis and anticoagulant-related nephropathy related to novel oral anticoagulants use.Ren. Fail. 2022; 44: 30-33
- Management of anticoagulant-related nephropathy: a single center experience.. 2021; 10: 796
- Anticoagulation-related nephropathy for the internist: a concise review.Am. J. Cardiovasc. Dis. 2020; 10: 301-305
- Anticoagulant-related nephropathy: systematic review and meta-analysis.Clin. Kidney J. 2019; 12: 400-407
- Anticoagulant-related nephropathy: a common, under-diagnosed clinical entity.Cureus. 2022; 14e22038
- Hepatic drug metabolism in rats with experimental chronic renal failure.Biochem. Pharmacol. 1984; 33: 711-716
- Haematuria as a risk factor for chronic kidney disease progression in glomerular diseases: a review.Pediatr. Nephrol. (Berlin, Germany). 2016; 31: 523-533
- IgA nephropathy is the most common underlying disease in patients with anticoagulant-related nephropathy.Kidney Int. Rep. 2022; 7: 831-840
- Anticoagulants and acute kidney injury: clinical and pathology considerations.Kidney Res. Clin. Pract. 2014; 33: 174-180
- Role of protease-activated receptor-1 (PAR-1) in the glomerular filtration barrier integrity.Physiol. Rep. 2022; 10e15343
- A case of rivaroxaban-associated acute tubulointerstitial nephritis.Neth. J. Med. 2017; 75: 169-171
- A case of dabigatran-associated acute renal failure.WMJ : official publication of the State Medical Society of Wisconsin. 2013; 112 (quiz 176): 173-175
- Acute renal failure in a patient with rivaroxaban-induced hypersensitivity syndrome: a case report with a review of the literature and of pharmacovigilance registries.Case Rep. Nephrol. 2020; 2020: 6940183
- A case report of Henoch-Schonlein purpura and IgA nephropathy associated with rivaroxaban.Nephrology (Carlton, Vic.). 2018; 23: 289-290
- Renoprotective effects of a factor xa inhibitor: fusion of basic research and a database analysis.Sci. Rep. 2018; 8: 10858
- Rivaroxaban, a direct factor xa inhibitor, ameliorates hypertensive renal damage through inhibition of the inflammatory response mediated by protease-activated receptor pathway.J. Am. Heart Assoc. 2019; 8e012195
- Warfarin: a double-edged sword.J. Family Med. Prim. Care. 2019; 8: 3045-3047
Article info
Publication history
Published online: December 17, 2022
Accepted:
December 9,
2022
Received in revised form:
November 29,
2022
Received:
October 24,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
