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Kidney Week

Abstract: SA-PO1085

Anticoagulants and the Kidney: 10 Years Later After Discovery of Warfarin Related Nephropathy

Session Information

Category: Pathology and Lab Medicine

  • 1502 Pathology and Lab Medicine: Clinical

Authors

  • Brodsky, Sergey V., The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Satoskar, Anjali A., The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Rovin, Brad H., The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Hemminger, Jessica, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Ryan, Margaret, Mayo Clinic , Scottsdale, Arizona, United States
  • Hebert, Lee A., Ohio State University Medical Center, Columbus, Ohio, United States
  • Nadasdy, Tibor, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
Background

Ten years ago we associated acute kidney injury (AKI) and occlusive red blood cell (RBC) tubular casts with high international normalized ratio (INR) in a patient on warfarin therapy. We named this condition warfarin related nephropathy (WRN). Later, we and others demonstrated that WRN is a part of the broader syndrome, anticoagulant related nephropathy (ARN). Herein we provide our 9-year experience with ARN based on a single-center renal pathology laboratory data.

Methods

The renal pathology database at the Ohio State University Wexner Medical Center (OSUWMC) was searched for native kidney biopsies performed between January 1st 2009 and December 31st 2017 using keywords “kidney biopsy”, “warfarin”, “anticoagulant”, “nephropathy”. All identified cases were reviewed and those with kidney biopsy findings suggestive of ARN were included into this study.

Results

Among 8636 native kidney biopsies, there were 47 (0.54 %) patients in whom deterioration in the kidney function could not be explained by kidney biopsy findings alone if anticoagulation was not taken into the equation. There were 32 (68%) males and 15 (32%) females, 90% of the patients were Caucasian. The average age was 61.7 +/- 14 years. Thirty five (74%) were on warfarin therapy, five (11%) were on anti-platelet medications, six (13%) did not have records of anticoagulation therapy, but they had acute coagulopathy at the time of deterioration of kidney function and their biopsy findings suggested of ARN. In addition to acute tubular necrosis and RBC casts, these patients had underlying glomerular changes, but the severity of that glomerular disease was out of proportion to the number of RBC casts and/or hematuria in these patients. The most common was mild glomerular immune complex deposits without significant proliferative lesions (23 cases, 49%), followed by mild focal pauci-immune crescentic glomerulonephritis (7 cases, 15%), diabetic glomerulosclerosis (5 cases, 11%) and focal segmental glomerular sclerosis (FSGS, 5 cases, 11%).

Conclusion

ARN is an uncommon diagnosis in renal pathology practice, but it should be considered when there is a disproportion between the severity of glomerular changes and the number of RBC casts and/or hematuria in a kidney biopsy in patients on anticoagulant therapy or who presented with acute coagulopathy.