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Oral Anticoagulants and Risk of Nephropathy

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Abstract

Anticoagulant-related nephropathy, a recently recognized entity, manifests as unexplained acute kidney injury in the setting of excessive anticoagulation with oral agents. Histologic findings in warfarin-related nephropathy include glomerular hemorrhage and renal tubular obstruction by red blood cells. Affected patients are at increased risk of mortality as well as irreversible kidney injury. Patients with chronic kidney disease are particularly vulnerable to this complication. Similar case reports of anticoagulant-related nephropathy have been linked to the more novel oral anticoagulant, dabigatran. Anticoagulant-related nephropathy has been successfully reproduced in rat models. These animal models shed light on the pathogenesis of the disease including the potential role of direct thrombin and protease-activated receptor-1 inhibition. Warfarin and dabigatran also cause an increase in systolic blood pressure in rats, a risk factor for developing nephropathy. This article reviews the current evidence for anticoagulant-related nephropathy and provides data for the suggested possible mechanisms underlying this adverse effect.

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Funding and conflict of interest

No sources of funding were used to assist in the preparation of this article. Vinay Narasimha Krishna, David G. Warnock, Nakshatra Saxena, and Dana V. Rizk have no conflicts of interest that are directly relevant to the content of this article.

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Authors and Affiliations

  1. Division of Nephrology, University of Alabama at Birmingham, ZRB 629, 1530 3rd Ave S, Birmingham, AL, 35294-0007, USA

    Vinay Narasimha Krishna, David G. Warnock & Dana V. Rizk

  2. UAB West, Birmingham, AL, USA

    Nakshatra Saxena

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  1. Vinay Narasimha Krishna
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  2. David G. Warnock
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  3. Nakshatra Saxena
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  4. Dana V. Rizk
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Correspondence to Dana V. Rizk.

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Narasimha Krishna, V., Warnock, D.G., Saxena, N. et al. Oral Anticoagulants and Risk of Nephropathy. Drug Saf 38, 527–533 (2015). https://doi.org/10.1007/s40264-015-0290-z

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