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Abstract: TH-PO072

Anticoagulant-Related Nephropathy in Patients with Mechanical Valves: A Challenging Case and a Possible Solution

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials


  • Song, Rui, Abington Memorial Hospital, Abington, Pennsylvania, United States
  • Al Hennawi, Hussam, Abington Memorial Hospital, Abington, Pennsylvania, United States
  • Shan Ul Abedin, Muhammad, Abington Memorial Hospital, Abington, Pennsylvania, United States
  • Khan, Majid A., Abington Memorial Hospital, Abington, Pennsylvania, United States

Anticoagulant-related nephropathy (ARN) is a novel form of acute kidney injury (AKI) associated with anticoagulant (AC) use. Management is challenging for patients on long-term AC who develop ARN.

Case Description

A 62-year-old Male with a history of chronic kidney disease [CKD, baseline serum creatinine (sCr) of 1.7 mg/dL], atrial fibrillation (Afib), mechanical aortic valve replacement on warfarin, and non-ischemic cardiomyopathy status post ICD insertion who presented with epistaxis. His medications include aspirin, carvedilol, furosemide, pantoprazole, simvastatin, and warfarin. He had a recent admission for AKI with microscopic hematuria needing workup for glomerulonephritis. The complements, ANA, ANCA, anti-GBM antibody, serum protein electrophoresis, and serum light chains were within normal range. Ultrasonography showed no evidence of kidney stones or hydronephrosis. The cause of AKI was unclear but his sCr improved to 1.96mg/dL from 2.5mg/dL after briefly holding warfarin for an INR of 3.9. Warfarin was continued on discharge. During this admission, labs showed a sCr level of 4.3 mg/dL and an INR of 5.8 on day 0. Warfarin was held and intravenous heparin drip was started. Patient had hematuria with a urine protein/creatinine ratio of 0.92 mg/g and a kidney biopsy was obtained for AKI on CKD. Pathology showed RBC casts and tubular injury consistent with ARN and underlying IgA nephropathy. His sCr improved to 1.7mg/dL and warfarin was restarted again on discharge. Five months later, he developed AKI on CKD requiring intermittent hemodialysis (HD). AC was held per the patient’s request. After holding warfarin, renal function recovered with no further HD needs. His sCr ranged between 1.7 to 2 mg/dL for the next six months. Due to the high risk of stroke given mechanical valve and Afib without AC, Cardiology, Hematology and Nephrology coordinated the care and a trial of apixaban 2.5 mg twice daily was started. His sCr has been followed closely and is stable to date.


ARN is often caused by high intensity warfarin usage but has been reported in patients on direct-acting oral AC. For patients with ARN needing lifelong AC, risks and benefits discussion is warranted. Multidisciplinary team effort is required. Trial of alternative low dose AC with close monitoring of sCr could be a possible solution.