Document Detail

Warfarin-related nephropathy occurs in patients with and without chronic kidney disease and is associated with an increased mortality rate.
MedLine Citation:
PMID:  21389969     Owner:  NLM     Status:  MEDLINE    
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.
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:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-03-09
Journal Detail:
Title:  Kidney international     Volume:  80     ISSN:  1523-1755     ISO Abbreviation:  Kidney Int.     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-07-01     Completed Date:  2011-12-29     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  0323470     Medline TA:  Kidney Int     Country:  United States    
Other Details:
Languages:  eng     Pagination:  181-9     Citation Subset:  IM    
Department of Pathology, Ohio State University, Columbus, Ohio 43210, USA.
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MeSH Terms
Chronic Disease
Erythrocyte Aggregation
International Normalized Ratio
Kidney Diseases / chemically induced*,  epidemiology*,  mortality
Kidney Tubules, Proximal / blood supply,  pathology
Risk Factors
Warfarin / adverse effects*
Grant Support
Reg. No./Substance:
Comment In:
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. 2012 Feb;81(3):322; author reply 323   [PMID:  22241561 ]
Kidney Int. 2011 Dec;80(11):1246   [PMID:  22083637 ]

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