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Warfarin-Related Nephropathy Manifested as Diffuse Mesangial Proliferative Glomerulonephritis
Frederick Acquah1, Nagapratap Ganta1, Dina Alnabwani1
1Internal Medicine, Hackensack Meridian Health, Ocean University Medical Center, Brick, USA.
Cureus
|March 30, 2022
Summary
Anticoagulant-related nephropathy (ARN) is a serious kidney complication of warfarin, affecting even those with normal kidney function. Regular monitoring of kidney function and warfarin dosage is crucial to prevent adverse outcomes.
Area of Science:
- Nephrology
- Pharmacology
- Internal Medicine
Background:
- Warfarin is a widely used anticoagulant.
- Anticoagulant-related nephropathy (ARN) is a recognized complication.
- Patients with chronic kidney disease (CKD) are particularly vulnerable to ARN.
Observation:
- An increasing number of ARN cases are being detected, including in patients with normal baseline kidney function.
- A correlation exists between rapid kidney function decline and elevated international normalized ratio (INR) levels (>3).
- A case of a 57-year-old female on warfarin presented with acute kidney injury and supratherapeutic INR.
Findings:
- Renal biopsy revealed diffuse mesangial proliferative glomerulonephritis in the presented case.
- ARN is underdiagnosed but linked to increased renal morbidity and mortality.
- Kidney function deterioration can occur even in patients with normal GFR.
Implications:
- Regular monitoring of kidney function in patients on warfarin is essential.
- Appropriate dose adjustment of warfarin is critical for patient safety.
- Increased awareness and timely diagnosis of ARN are needed to improve patient outcomes.
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