Document Detail

Acute kidney injury during warfarin therapy associated with obstructive tubular red blood cell casts: a report of 9 cases.
MedLine Citation:
PMID:  19577348     Owner:  NLM     Status:  MEDLINE    
Acute kidney injury (AKI) during warfarin therapy usually is hemodynamic secondary to massive blood loss. Here, we report pathological findings in kidney biopsy specimens from 9 patients with warfarin overdose, hematuria, and AKI. Kidney biopsy specimens from patients on warfarin therapy with AKI were identified in our database within a 5-year period. Each kidney biopsy specimen was evaluated by using semiquantitative morphometric techniques, and medical history was reviewed for conditions explaining AKI. Biopsy specimens with morphological findings of active glomerulonephritis and active inflammatory lesions were excluded from the study. Biopsy specimens from 9 patients were selected. At presentation with AKI, each patient had an abnormal international normalized ratio (mean 4.4 +/- 0.7 IU) and increased serum creatinine level (mean, 4.3 +/- 0.8 mg/dL). Morphologically, each biopsy specimen showed evidence of acute tubular injury and glomerular hemorrhage: red blood cells (RBCs) in Bowman space and numerous occlusive RBC casts in tubules. Each biopsy specimen showed chronic kidney injury. Six of 9 patients did not recover from AKI. These data suggest that warfarin therapy can result in AKI by causing glomerular hemorrhage and renal tubular obstruction by RBC casts. Our experience suggests that this may be a potentially serious complication of warfarin therapy, especially in older patients with underlying chronic kidney injury.
Sergey V Brodsky; Anjali Satoskar; Jun Chen; Gyongyi Nadasdy; Jeremiah W Eagen; Mirza Hamirani; Lee Hebert; Edward Calomeni; Tibor Nadasdy
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2009-07-04
Journal Detail:
Title:  American journal of kidney diseases : the official journal of the National Kidney Foundation     Volume:  54     ISSN:  1523-6838     ISO Abbreviation:  Am. J. Kidney Dis.     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-11-25     Completed Date:  2009-12-16     Revised Date:  2012-10-29    
Medline Journal Info:
Nlm Unique ID:  8110075     Medline TA:  Am J Kidney Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1121-6     Citation Subset:  IM    
Department of Pathology, The Ohio State University, Columbus, OH 43210, USA.
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MeSH Terms
Acute Kidney Injury / chemically induced*,  diagnosis,  pathology*
Aged, 80 and over
Anticoagulants / adverse effects*,  therapeutic use
Erythrocytes / pathology*
Hematuria / chemically induced,  diagnosis,  pathology
Hemorrhage / chemically induced,  diagnosis,  pathology
Kidney / pathology
Kidney Tubules, Proximal / pathology*
Middle Aged
Thrombosis / prevention & control
Warfarin / adverse effects*,  therapeutic use
Grant Support
Reg. No./Substance:
0/Anticoagulants; 81-81-2/Warfarin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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