Gültekin Nazmi, Akın Fatih, Küçükateş Emine
Department of Cardiology, Cardiology Institute, İstanbul University, İstanbul, Turkey.
Turk Kardiyol Dern Ars. 2011 Apr;39(3):228-30. doi: 10.5543/tkda.2011.01173.
Acute renal failure due to bilateral hematoma is a rare complication of anticoagulant warfarin therapy. A 43-year-old man presented with complaints of hematuria and abdominal pain. He had been receiving warfarin for six years, after placement of an aortic valve prosthesis. One week prior to admission, he sustained a urinary tract infection which was treated with third-generation cephalosporin and indomethacin. His serum creatinine level was 1.8 mg/dl with an INR of 15. Three days later, he developed anuria and was treated with hemodialysis. Renal ultrasonography disclosed moderate bilateral hydronephrosis. Computed tomography without contrast enhancement showed bilateral extensive hyperdense thickening of the renal and ureteral walls and high-attenuation areas. Conservative treatment was preferred and diuresis resumed spontaneously, lumbar pain disappeared, and serum creatinine level returned to normal. One month later, renal computed tomography was found normal.
双侧血肿所致急性肾衰竭是抗凝剂华法林治疗罕见的并发症。一名43岁男性因血尿和腹痛就诊。他在植入主动脉瓣假体后接受华法林治疗已六年。入院前一周，他患了尿路感染，接受了第三代头孢菌素和吲哚美辛治疗。他的血清肌酐水平为1.8mg/dl，国际标准化比值（INR）为15。三天后，他出现无尿，接受了血液透析治疗。肾脏超声检查显示双侧中度肾积水。未增强的计算机断层扫描显示肾壁和输尿管壁双侧广泛高密度增厚以及高密度区域。首选保守治疗，随后尿量自发恢复，腰痛消失，血清肌酐水平恢复正常。一个月后，肾脏计算机断层扫描显示正常。
