From a commentary
in JACC, here are some key points.
What is it?
Anticoagulant related nephropathy (ARN) is a form of AKI caused by
systemic anticoagulation (generally over anticoagulation; in the
original reports on warfarin the mean INR was in the mid 4 range).
What are the
histopathologic findings?
Severe glomerular, and sometimes tubular, hemorrhage.
It's not just
warfarin
Although originally described with warfarin and termed warfarin
nephropathy it is now evident that other systemic anticoagulants (and
probably any systemic anticoagulant) can cause it. The risk may be
higher with warfarin than with the NOACs.
How do you
diagnose it?
The difficulties in getting a renal biopsy in patients who are
anticoagulated are obvious. Sometimes biopsy is done during a window
of anticoagulant interruption. In other cases, if circumstances fit
and there is no other plausible explanation “presumptive ARN” is
diagnosed without a biopsy.
It is generally
not reversible
According to the article, renal recovery tends to be poor.
During periods of
excessive anticoagulation the risk is high
From the article:
To date, there have been 5 independent cohort studies...These studies show that the risk of ARN at the onset of coagulopathy is at about 20% overall and about 37% in patients with CKD (3).
According to the article the mortality is high, especially in CKD
patients.
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