Warfarin Related Nephropathy:
The First Case Report in Thailand
Nuttasith Larpparisuth MD*,
Bunyarit Cheunsuchon MD**, Ratana Chawanasuntorapoj MD*,
Somkiat Vasuvattakul MD*, Kriengsak Vareesangthip MD*
Affiliation :
* Division of Nephrology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
** Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Warfarin is the most prescribed oral anticoagulant. Adverse renal effect from warfarin therapy are uncommon
and Thailand is not acquainted. Warfarin-related nephropathy (WRN) is a newly recognized complication of warfarin
treatment, especially in patients with chronic kidney disease. The authors hereby report a 56-year-old man who developed
gross hematuria and severe acute kidney injury (AKI) necessitating hemodialysis, following supra-therapeutic INR level.
Renal pathology revealed extensive intratubular obstruction with red blood cell casts. From the literature, there were only
twelve case reports of WRN, which were confirmed by renal histopatology. Renal survival of this condition was unsatisfactory.
However, our patient was dialysis-independent after vitamin K treatment and temporary warfarin discontinuation. To the
best of our knowledge, this is the first case report of biopsy-proven WRN in Thailand.
Keywords : Warfarin, Warfarin related nephropathy, Acute kidney injury, Intratubular hemorrhage, Gross hematuria,
Anticoagulants
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