Warfarin and acute kidney injury
Journal of the American College of Cardiology
View large Download slide. Based on our data, the hypertensive effect of warfarin does not change with CKD progression. Effects of warfarin on blood pressure in men with diabetes and hypertension—a longitudinal study. Renal pathologists often do not recognize WRN because of an underlying kidney disease.
Over the next few days, his azotemia showed a settling trend. Treatment with vitamin K prevented serum creatinine increase and morphologic changes in the kidney associated with warfarin treatment . Her baseline serum creatinine was normal. See "Diagnostic approach to adult patients with subacute kidney injury in an outpatient setting" and "Glomerular disease: Serum albumin concentration was normal 4.
We found that NAC in a dose-dependent manner prevents serum creatinine increase associated with excessive anticoagulation by warfarin.
Intrarenal bleeding may be suburothelial, intraparenchymal, subcapsular, perinephric or pararenal [ 1011 ]. In addition, anticoagulants may aggravate an underlying kidney disease and induce hematuria and AKI .
Their data confirmed our observations, including a high incidence of WRN. Warfarin is the most commonly prescribed oral anticoagulant worldwide. Since WRN represents a severe complication with a poor renal prognosis [ 4 ], the identification of patients at risk is important. These data suggest that CKD patients may not be at a higher risk for hypertension associated with warfarin. The provisional diagnosis was acute kidney injury AKI in the background of over anti-coagulation and diabetes mellitus.
Immunofluorescence showed mild smudgy staining for immunoglobulin G IgG Fig. Here are two recent examples of WRN diagnosis from our practice. Efficacy and safety of sofosbuvir-based antiviral therapy to treat hepatitis C virus infection after kidney transplantation.
Based on these publications, the key clinical features of WRN are: Electron microscopy showed scattered small electron dense immune-type complex deposits Fig. UpToDate is the most trusted clinical decision support resource in the world. Currently, the data does not support the use of haematuria as a surrogate for the presence of WRN. In vitro studies indicate that PAR-1 activation changes endothelial monolayer integrity .
In general warfarin pharmacogenetics may indicate a genetic predisposition to WRN and act as a guide for dose requirements in CKD patients.
The variable rate of detection of occult lesions may also reflect the different diagnostic approaches, ranging from comprehensive tests CT, IVP and cystoscopy to single imaging.