Rivaroxaban-related nephropathy

• Autor(a) principal: Oliveira,Miguel
• Data de Publicação: 2017
• Outros Autores: Lima,Carla, Góis,Mário, Viana,Helena, Carvalho,Fernanda, Lemos,Sérgio
• Tipo de documento: Relatório
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692017000300008
• topic: Acute kidney injury; Anticoagulant-related nephropathy; Novel oral anticoagulants; Rivaroxaban

Novel oral anticoagulants (NOAC) are a group of drugs recently approved for the treatment of patients at high risk of arterial or venous thrombosis. Unlike vitamin K antagonists, NOAC have a faster onset of action, less drug interactions and do not need frequent monitoring, making their prescription more convenient for physicians and patients. However, both classes of drugs have the potential for nephrotoxicity. Anticoagulation-related nephropathy is a form of acute kidney injury caused by excessive anticoagulation, resulting in glomerular haemorrhage and tubular obstruction by red blood casts. It was first described with warfarin, but new cases have been reported with acenocumarol and dabigatran. We report a case of a 82-year-old woman suffering from atrial fibrillation under rivaroxaban treatment with previous normal renal function, admitted to our unit with gross haematuria and acute kidney injury. A renal biopsy revealed typical features of anticoagulant-related nephropathy superimposed on chronic interstitial nephritis and hypertensive nephroangiosclerosis. There was no recovery of renal function despite withdrawal of rivaroxaban and the patient started on chronic haemodialysis three months after initial episode. To the best of our knowledge, this is the first case of a patient with a biopsy-proven anticoagulant nephropathy related to rivaroxaban. As novel oral anticoagulants are increasingly being prescribed and available data on their safety concerning renal toxicity are scarce, this report highlights the importance of a cautious prescription of these drugs and regular clinical and laboratory evaluation to avoid poor clinical outcomes.