From Clot Prevention to Kidney Injury: Revisiting Anticoagulant-Related Nephropathy

Anticoagulant-related nephropathy (ARN) is a serious and often underrecognized complication of anticoagulant therapy. Initially associated with vitamin K antagonists such as warfarin, ARN has also been increasingly linked to direct oral anticoagulants, including dabigatran, rivaroxaban, edoxaban, and apixaban. The condition is characterized by acute kidney injury (AKI), macroscopic hematuria, glomerular hemorrhage, and red blood cell casts within renal tubules.

Although once considered rare, growing evidence suggests ARN is more common than previously believed, especially in patients with preexisting chronic kidney disease (CKD). The prognosis is often poor: over half of affected patients fail to recover baseline kidney function within a year, and non-recovering patients face markedly increased mortality, with some studies reporting a 1-year mortality rate as high as 39%. Treatment strategies have included anticoagulant withdrawal, supportive measures, and corticosteroids, yet no standardized or definitive therapy has been established. This review examines current data on the epidemiology, pathophysiology, diagnosis, and therapeutic options for ARN.

ARN is an increasingly recognized cause of AKI in anticoagulated patients, particularly those with CKD. The condition is often associated with incomplete or absent renal recovery and significantly higher mortality in non-recovering patients. Therefore, early recognition and appropriate risk stratification are crucial, although current treatment options remain largely supportive. Further research is needed to establish validated diagnostic criteria and effective therapeutic strategies.