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When haematuria is more than warfarin: lambda-predominant IgA nephropathy
Benny Chia Wue Lim1, Fauzah Binti Abd Ghani2, Fuah Kar Wah1
1Department of Nephrology, Hospital Sultan Idris Shah, Serdang, Malaysia.
BMJ Case Reports
|February 25, 2026
Summary
A young woman on warfarin developed acute kidney injury (AKI) and hematuria. Renal biopsy revealed immunoglobulin A nephropathy, leading to conservative management and favorable recovery, underscoring biopsy importance.
Area of Science:
- Nephrology
- Hematology
- Internal Medicine
Background:
- A woman on warfarin therapy for mechanical mitral valve replacement presented with hematuria and acute kidney injury (AKI).
- Initial assessment suggested anticoagulant-related nephropathy as the cause.
- Persistent urinary abnormalities prompted further investigation.
Purpose of the Study:
- To investigate the cause of persistent hematuria and AKI in a patient on anticoagulation.
- To highlight the diagnostic utility of renal biopsy in complex cases.
- To evaluate conservative management strategies for specific renal pathologies.
Main Methods:
- Clinical presentation review and initial diagnostic workup.
- Renal biopsy for histopathological examination.
- Conservative management with antiproteinuric therapy.
Main Results:
- Renal biopsy identified immunoglobulin A nephropathy with lambda light chain predominance.
- This finding raised suspicion for an underlying monoclonal gammopathy.
- The patient experienced favorable renal recovery with conservative management alone.
Conclusions:
- Renal biopsy is crucial for accurate diagnosis in patients with hematuria and AKI, especially those on anticoagulation.
- Immunoglobulin A nephropathy with monoclonal gammopathy can present insidiously.
- Conservative management may be effective for certain renal conditions, avoiding immunosuppression.
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