Anticoagulant Related Nephropathy Induced by Dabigatran.
Nazia SharfuddinMahra NourbakhshAlan BoxHallgrimur BenediktssonDaniel A MuruvePublished in: Case reports in nephrology (2018)
We describe a case of biopsy-proven dabigatran related nephropathy in a patient without underlying IgA nephropathy. To date, dabigatran related nephropathy was only reported in patients with concurrent or undiagnosed IgA nephropathy, suggesting that it may predispose patients to dabigatran associated injury. The patient is an 81-year-old woman with multiple medical comorbidities, including nonvalvular atrial fibrillation, who was anticoagulated with dabigatran. She presented to hospital with acute kidney injury in the setting of volume overload. Her estimated glomerular filtration rate decreased from a baseline of 57 mL/min/1.73 m2 to 4 mL/min/1.73 m2, necessitating hemodialysis. Renal ultrasound findings, fractional excretion of sodium, and urinalysis suggested acute kidney injury. Renal biopsy showed acute tubular injury, tubular red blood cell casts, and an absence of active glomerulonephritis, similar to the pathological findings of warfarin related nephropathy. A diagnosis of anticoagulant related nephropathy secondary to dabigatran was therefore established. This case demonstrates that dabigatran, like warfarin, may increase tubular bleeding risk in patients, irrespective of underlying kidney or glomerular disease.
Keyphrases
- atrial fibrillation
- oral anticoagulants
- catheter ablation
- left atrial
- end stage renal disease
- direct oral anticoagulants
- left atrial appendage
- chronic kidney disease
- acute kidney injury
- heart failure
- healthcare
- ejection fraction
- red blood cell
- prognostic factors
- percutaneous coronary intervention
- squamous cell carcinoma
- peritoneal dialysis
- coronary artery disease
- intensive care unit
- emergency department
- drug induced
- left ventricular
- mitral valve
- acute coronary syndrome
- extracorporeal membrane oxygenation
- cardiac surgery
- acute respiratory distress syndrome
- diabetic nephropathy
- locally advanced