| Warfarin-related nephropathy occurs in patients with and without chronic kidney disease and is associated with an increased mortality rate. | |
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MedLine Citation:
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PMID: 21389969 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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An acute increase in the international normalized ratio (INR; a comparison of prothrombin time to monitor the effects of warfarin) over 3 in patients with chronic kidney disease (CKD) is often associated with an unexplained acute increase in serum creatinine (SC) and an accelerated progression of CKD. Kidney biopsy in a subset of these patients showed obstruction of the renal tubule by red blood cell casts, and this appears to be the dominant mechanism of the acute kidney injury. We termed this warfarin-related nephropathy (WRN), and previously reported cases of WRN only in patients with CKD. We now assess whether this occurs in patients without CKD, its risk factors, and consequences. In 15,258 patients who initiated warfarin therapy during a 5-year period, 4006 had an INR over 3 and SC measured at the same time; however, the large data set precluded individual patient clinical assessment. A presumptive diagnosis of WRN was made if the SC increased by over 0.3 mg/dl within 1 week after the INR exceeded 3 with no record of hemorrhage. WRN occurred in 20.5% of the entire cohort, 33.0% of the CKD cohort, and 16.5% of the no-CKD cohort. Other risk factors included age, diabetes mellitus, hypertension, and cardiovascular disease. The 1-year mortality was 31.1% with compared with 18.9% without WRN, an increased risk of 65%. Thus, WRN may be a common complication of warfarin therapy in high-risk patients and CKD doubles this risk. The mechanisms of these risks are unclear. |
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Authors:
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Sergey V Brodsky; Tibor Nadasdy; Brad H Rovin; Anjali A Satoskar; Gyongyi M Nadasdy; Haifeng M Wu; Udayan Y Bhatt; Lee A Hebert |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2011-03-09 |
Journal Detail:
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Title: Kidney international Volume: 80 ISSN: 1523-1755 ISO Abbreviation: Kidney Int. Publication Date: 2011 Jul |
Date Detail:
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Created Date: 2011-07-01 Completed Date: 2011-12-29 Revised Date: 2012-10-29 |
Medline Journal Info:
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Nlm Unique ID: 0323470 Medline TA: Kidney Int Country: United States |
Other Details:
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Languages: eng Pagination: 181-9 Citation Subset: IM |
Affiliation:
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Department of Pathology, Ohio State University, Columbus, Ohio 43210, USA. sergey.brodsky@osumc.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Biopsy Chronic Disease Erythrocyte Aggregation Humans International Normalized Ratio Kidney Diseases / chemically induced*, epidemiology*, mortality Kidney Tubules, Proximal / blood supply, pathology Mortality Risk Factors Warfarin / adverse effects* |
| Grant Support | |
ID/Acronym/Agency:
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UL1 RR025755/RR/NCRR NIH HHS |
| Chemical | |
Reg. No./Substance:
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81-81-2/Warfarin |
| Comments/Corrections | |
Comment In:
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Kidney Int. 2011 Jul;80(2):131-3
[PMID:
21720303
]
Kidney Int. 2012 Jul;82(1):113; author reply 113-4 [PMID: 22699379 ] Kidney Int. 2011 Dec;80(11):1246 [PMID: 22083637 ] Kidney Int. 2012 Feb;81(3):322; author reply 323 [PMID: 22241561 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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