Antikoagülan ilişkili nefropati

Antikoagülan ilişkili nefropati, varfarin veya diğer antikoagülan ajanlarla antikoagülasyonun neden olduğu bir tür akut böbrek hasarıdır. INR> 4 olduğunda antikoagülan ilişkili nefropati gelişim riskinin arttığı görülmektedir. Bu yazıda supraterapötik doz varfarin kullanımı sonucu akut böbrek hasarı gelişen bir olgu sunulmuştur. Atrial fibrilasyon nedeniyle varfarin kullanan, eşlik eden, obezite, hipertansiyon, tip 2 diabetes mellitus ve kronik böbrek hastalığı tanıları olan 61 yaşında erkek hasta sol böğründe şişlik ve morluk ile acil servise başvurdu. Göğüs sol posterolateral duvarında hematomu olan hastanın laboratuvar analizlerinde INR:9,7 serum kreatinin seviyesi bazal değerinin 2 katının üzerinde (bazal değeri:3mg/dL, en yüksek:6,2mg/dL) saptandı. Hemoglobin 6,8 g/dL’ye kadar düştü. Varfarin kesilip INR güvenli aralığa çekilmesiyle hastanın serum kreatinini bazal düzeyine geriledi. Akut böbrek hasarı yapabilecek diğer nedenler dışlandı ve supraterapötik doz varfarin kullanımı olan hastada antikoagülan ilişkili nefropati geliştiği düşünüldü. Bu olgu komorditeleri fazla olan özellikle kronik böbrek hastalarında antikoagülan tedavilerin dikkatli takip gerektirdiğini göstermektedir. Antikoagülan kullanan hastalarda akut böbrek hasarı etiyolojisinde antikoagülan ilişkili nefropati akılda tutulmalıdır.

Anahtar Kelimeler:

Antikoagülan, varfarin, akut böbrek hasarı, kronik böbrek hastalığı

Anticoagulant-related nephropathy

Anticoagulant-related nephropathy is a type of acute kidney injury caused by anticoagulation with warfarin or other anticoagulant agents. It appears that the risk of developing anticoagulant-related nephropathy increases when INR> 4. In this article, we present a case who developed acute kidney injury as a result of supratherapeutic dose of warfarin. A 61-year-old male patient, who was on warfarin treatment for atrial fibrillation and had comorbid hypertension, type 2 diabetes mellitus and chronic kidney disease, presented to the emergency department with swelling and bruising on his left flank area. He had a hematoma on the left posterolateral wall of the chest. In the laboratory analysis INR: 9.7 and serum creatinine level was above 2 times the baseline value (baseline:3 mg/dL, maximum:6,2 mg/dL). By discontinuing warfarin, INR returned to the safe range and serum creatinine decreased to his baseline levels. Other causes of acute kidney injury were excluded, and the patient with supratherapeutic dose of warfarin was thought to develop anticoagulant-related nephropathy. This case shows that anticoagulant therapies require careful follow-up in patients with comorbidites especially chronic kidney disease. Anticoagulant related nephropathy should be kept in mind in the etiology of acute kidney injury in patients using anticoagulants.

Keywords:

anticoagulant, warfarin, acute kidney injury, chronic kidney disease,

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