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Anticoagulant-related nephropathy

Sergey V Brodsky, MD, PhD
Brad H Rovin, MD
Lee A Hebert, MD
Section Editor
Paul M Palevsky, MD
Deputy Editor
Alice M Sheridan, MD


Anticoagulant-related nephropathy (also referred to as warfarin-related nephropathy) is a type of acute kidney injury (AKI) that may be caused by excessive anticoagulation with warfarin and other anticoagulants [1]. Anticoagulant-related nephropathy has been associated with irreversible kidney injury in some patients and with increased risk of mortality.

While initially termed "warfarin-related nephropathy," we use the term "anticoagulant-related nephropathy" because the entity has been associated with anticoagulants other than warfarin [2].

This topic reviews the epidemiology, pathogenesis, clinical features, and treatment of anticoagulant-related nephropathy. The differential diagnosis of AKI, glomerulonephritis, and hematuria are discussed elsewhere. (See "Diagnostic approach to adult patients with subacute kidney injury in an outpatient setting" and "Glomerular disease: Evaluation and differential diagnosis in adults" and "Etiology and evaluation of hematuria in adults".)


Acute kidney injury (AKI) resulting from glomerular hemorrhage has been described in patients with glomerular lesions (ie, kidney disease) in the absence [3-5] and presence [6,7] of coagulopathy (International Normalized Ratio [INR] 6 to 9 range). More recently, AKI has been described among patients without underlying kidney disease and with more modest elevations of INR [8]. A detailed biopsy study of nine patients who developed otherwise unexplained AKI in association with warfarin overdose revealed the predominant lesion of tubular injury and obstruction with red blood cells (RBCs) and RBC casts [9]. The recognition of a characteristic histologic lesion that was associated with the clinical presentation of otherwise unexplained AKI in the setting of over-anticoagulation led to the term "anticoagulant-related nephropathy."

The incidence of anticoagulant-related nephropathy is difficult to determine. This is because studies that have examined incidence have relied upon a presumptive diagnosis of anticoagulant-related nephropathy (defined by an elevation in the serum creatinine within several days of an abnormally elevated INR) rather than a more definitive diagnosis (defined by biopsy) [8,10,11]. (See 'Diagnosis' below.)

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Literature review current through: Nov 2017. | This topic last updated: Mar 28, 2016.
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