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Edoxaban-induced acute interstitial nephritis.

Shiko Gen1, Ririko Higashi2, Natsuki Nagae2

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A 76-year-old man developed acute kidney injury after starting edoxaban, a medication for atrial fibrillation. Diagnosis confirmed edoxaban-induced acute interstitial nephritis, highlighting the need to consider drug reactions in kidney injury.

Keywords:
Acute interstitial nephritisAnticoagulant-related nephropathyEdoxaban

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Area of Science:

  • Nephrology
  • Pharmacology
  • Internal Medicine

Background:

  • Atrial fibrillation is a common arrhythmia requiring anticoagulant therapy.
  • Edoxaban is a direct oral anticoagulant used for stroke prevention.
  • Acute kidney injury (AKI) can occur after initiating anticoagulant drugs.

Purpose of the Study:

  • To investigate the cause of acute kidney injury in a patient treated with edoxaban.
  • To differentiate between anticoagulant-related nephropathy and other causes of AKI.
  • To report a case of edoxaban-induced acute interstitial nephritis.

Main Methods:

  • A 76-year-old male patient with atrial fibrillation was initiated on edoxaban.
  • Renal function was monitored, and acute kidney injury was observed 7 days post-initiation.
  • Renal biopsy and drug-induced lymphocyte stimulation test were performed for diagnosis.

Main Results:

  • Renal biopsy revealed interstitial inflammatory cell infiltration (lymphocytes, plasma cells) without red blood cell casts.
  • The drug-induced lymphocyte stimulation test for edoxaban was positive.
  • A diagnosis of edoxaban-induced acute interstitial nephritis was established.

Conclusions:

  • Acute interstitial nephritis is a potential cause of AKI following edoxaban initiation.
  • Drug-induced interstitial nephritis should be considered alongside anticoagulant-related nephropathy in AKI cases.
  • This case underscores the importance of considering drug toxicity in patients with new-onset renal dysfunction during anticoagulant therapy.