Rivaroxaban-Induced Acute Interstitial Nephritis: A Case Report

Patient: Male, 70 Final Diagnosis: Acute interstitial nephritis Symptoms: Dark color urine, difficult voiding Medication: Rivaroxaban Clinical Procedure: — Specialty: General and Internal Medicine OBJECTIVE: Challenging differential diagnosis BACKGROUND: Direct oral anticoagulant agents (DOACs) have become increasingly more popular in recent years and have largely replaced warfarin in the treatment of certain conditions, such as atrial fibrillation, and in the prevention of thromboembolic events. Rivaroxaban is one of the most commonly used direct anticoagulant drugs for conditions such as atrial fibrillation and thromboprophylaxis. CASE REPORT: We present a case of a 70-year-old male who developed acute interstitial nephritis after starting rivaroxaban, and who responded to medical treatment, which included corticosteroid therapy. A renal biopsy was not performed because the patient was on essential anticoagulation therapy secondary to a high CHADS2VASc score. CONCLUSIONS: Dose adjustments when using rivaroxaban are necessary in patients with underlying renal failure. Acute interstitial nephritis is a rare condition associated with direct anticoagulant drugs. The treatment of acute interstitial nephritis is usually to remove the offending agent and treat the underlying cause.