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Management of Anticoagulant-Related Nephropathy: A Single Center Experience

Background: Anticoagulant-related nephropathy (ARN) is a form of acute kidney injury that mainly occurs in patients with previously unrecognized glomerular disease in addition to excessive anticoagulation. Since a renal biopsy is not performed in most cases, the diagnosis is often presumptive. Metho...

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Autores principales: Belčič Mikič, Tanja, Kojc, Nika, Frelih, Maja, Aleš-Rigler, Andreja, Večerić-Haler, Željka
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920283/
https://www.ncbi.nlm.nih.gov/pubmed/33669373
http://dx.doi.org/10.3390/jcm10040796
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author Belčič Mikič, Tanja
Kojc, Nika
Frelih, Maja
Aleš-Rigler, Andreja
Večerić-Haler, Željka
author_facet Belčič Mikič, Tanja
Kojc, Nika
Frelih, Maja
Aleš-Rigler, Andreja
Večerić-Haler, Željka
author_sort Belčič Mikič, Tanja
collection PubMed
description Background: Anticoagulant-related nephropathy (ARN) is a form of acute kidney injury that mainly occurs in patients with previously unrecognized glomerular disease in addition to excessive anticoagulation. Since a renal biopsy is not performed in most cases, the diagnosis is often presumptive. Methods: Here, we present the characteristics of a national Slovenian patient cohort with histologically verified ARN, from the first case in 2014 to December 2020, and a review of the current literature (Pubmed database). Results: In Slovenia, ARN has been detected in 13 patients, seven of whom were treated with coumarins, and others with direct oral anticoagulants. In seven patients, ARN appeared after excessive anticoagulation. As many as 11 patients had underlying IgA nephropathy. Similar to the global data presented here, the pathohistological impairment associated with pre-existing glomerulopathy was mild and disproportionate to the degree of functional renal impairment. The majority of our patients with ARN experienced severe deterioration of renal function associated with histological signs of accompanying acute tubular injury, interstitial edema, and occlusive red blood cell casts. These patients were treated with corticosteroids, which (in addition to supportive treatment and discontinuation of the anticoagulant drug) led to a further improvement in renal function. Conclusions: Anticoagulant therapy combined with a pre-existing glomerular injury may lead to ARN. In addition to discontinuation of the anticoagulant and supportive care, corticosteroids, which are currently listed in only a few cases in the world literature, may have a positive influence on the course of treatment. However, the benefits of steroid treatment must be weighed against the risk of complications, especially life-threatening infections.
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spelling pubmed-79202832021-03-02 Management of Anticoagulant-Related Nephropathy: A Single Center Experience Belčič Mikič, Tanja Kojc, Nika Frelih, Maja Aleš-Rigler, Andreja Večerić-Haler, Željka J Clin Med Article Background: Anticoagulant-related nephropathy (ARN) is a form of acute kidney injury that mainly occurs in patients with previously unrecognized glomerular disease in addition to excessive anticoagulation. Since a renal biopsy is not performed in most cases, the diagnosis is often presumptive. Methods: Here, we present the characteristics of a national Slovenian patient cohort with histologically verified ARN, from the first case in 2014 to December 2020, and a review of the current literature (Pubmed database). Results: In Slovenia, ARN has been detected in 13 patients, seven of whom were treated with coumarins, and others with direct oral anticoagulants. In seven patients, ARN appeared after excessive anticoagulation. As many as 11 patients had underlying IgA nephropathy. Similar to the global data presented here, the pathohistological impairment associated with pre-existing glomerulopathy was mild and disproportionate to the degree of functional renal impairment. The majority of our patients with ARN experienced severe deterioration of renal function associated with histological signs of accompanying acute tubular injury, interstitial edema, and occlusive red blood cell casts. These patients were treated with corticosteroids, which (in addition to supportive treatment and discontinuation of the anticoagulant drug) led to a further improvement in renal function. Conclusions: Anticoagulant therapy combined with a pre-existing glomerular injury may lead to ARN. In addition to discontinuation of the anticoagulant and supportive care, corticosteroids, which are currently listed in only a few cases in the world literature, may have a positive influence on the course of treatment. However, the benefits of steroid treatment must be weighed against the risk of complications, especially life-threatening infections. MDPI 2021-02-16 /pmc/articles/PMC7920283/ /pubmed/33669373 http://dx.doi.org/10.3390/jcm10040796 Text en © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Belčič Mikič, Tanja
Kojc, Nika
Frelih, Maja
Aleš-Rigler, Andreja
Večerić-Haler, Željka
Management of Anticoagulant-Related Nephropathy: A Single Center Experience
title Management of Anticoagulant-Related Nephropathy: A Single Center Experience
title_full Management of Anticoagulant-Related Nephropathy: A Single Center Experience
title_fullStr Management of Anticoagulant-Related Nephropathy: A Single Center Experience
title_full_unstemmed Management of Anticoagulant-Related Nephropathy: A Single Center Experience
title_short Management of Anticoagulant-Related Nephropathy: A Single Center Experience
title_sort management of anticoagulant-related nephropathy: a single center experience
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920283/
https://www.ncbi.nlm.nih.gov/pubmed/33669373
http://dx.doi.org/10.3390/jcm10040796
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