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Kidney Week

Abstract: PO0281

Case Report of Rivaroxaban-Induced Anticoagulant-Related Nephropathy

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Fadel, Remy, North Florida Regional Medical Center, Gainesville, Florida, United States
  • Habib, Raiya, Dow Medical College, Karachi, Pakistan
  • Walker, Patrick D., Arkana Laboratories, Little Rock, Arkansas, United States
  • Alfino, Paul A., North Florida Regional Medical Center, Gainesville, Florida, United States
  • Murphy, Joel D., Arkana Laboratories, Little Rock, Arkansas, United States
  • Kaleem, Ayesha, North Florida Regional Medical Center, Gainesville, Florida, United States
Introduction

Anticoagulant related nephropathy (ARN) is still an under recognized etiology of acute kidney injury (AKI). There are no guidelines for ARN treatment to date and the literature consists mostly of case reports. While early detection of AKI remains the most important treatment, discontinuing the offending agent and antidote administration are also crucial. Other measures utilized include administering fluids and urine alkalinization to minimize red cell precipitation.

Case Description

Our patient is a 63-year-old Hispanic male treated with Rivaroxaban for atrial fibrillation. He started experiencing increased hemorrhaging with progressive worsening kidney function over two months. His serum creatinine (sCr) increased to 3.35mg/dL from 0.83mg/dL. Initial work up only revealed hematuria on a urinalysis. Serologies including auto-immune and hepatitis panels were negative. Subsequently, a renal biopsy done revealed chronic IgA nephropathy and acute tubular injury with prominent RBC casts and intratubular red blood cells. This was suggestive of ARN in the absence of glomerular dysfunction.
The causative agent was held and a bicarbonate infusion was initiated. The patient’s renal function improved with a most recent sCr of 1.5 mg/dL consistent with an estimated glomerular filtration rate (eGFR) of 50 ml/min/1.73m2 improved from 19, approximately 7 months after initial treatment.

Discussion

Our case provides another example of ARN and highlights the therapeutic measures utilized. ARN has previously been shown to hasten CKD progression with increased mortality. Early identification and therapeutic management can lead to considerable renal recovery as seen in our patient’s case. More studies are needed to further clarify the pathophysiology of ARN and to investigate potential treatments.

Figure 1. Kidney biopsy specimen under light microscopy