Nishio Shinichiro, Tsuboi Nobuo, Kurashige Mahiro, Tanaka Mai, Ueda Hiroyuki, Yokoo Takashi, Miyazaki Yoichi, Utsunomiya Yasunori, Hosoya Tatsuo
Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Nihon Jinzo Gakkai Shi. 2013;55(5):966-71.
The patient was an 82-year-old female. She had been treated with warfarin for atrial fibrillation that developed after a heart valve replacement operation. She was admitted because of a progressive loss of renal function together with persistent microscopic hematuria and proteinuria. Although the renal biopsy showed only focal mononuclear cell infiltration and mild mesangial expansion in the glomeruli, the occlusive red blood cell casts were remarkable in the tubules and were accompanied by inflammatory and edematous changes in the surrounding interstitial area. After the adjustment of an excessively extended prothrombin time, her renal function gradually improved in parallel with the marked decrease in the microhematuria. It was assumed that an acute kidney injury observed in this case was caused by the occlusive red blood cell casts as a result of abnormal hemorrhage in the glomeruli due to focal glomerulonephritis and a warfarin overdose. The present case, therefore, suggests that a warfarin overdose is a potential risk factor for acute kidney injury in the presence of coexisting glomerular injury.
该患者为一名82岁女性。她因心脏瓣膜置换术后发生心房颤动而接受华法林治疗。她因肾功能进行性减退伴持续性镜下血尿和蛋白尿入院。尽管肾活检显示肾小球仅局灶性单核细胞浸润和轻度系膜扩张，但肾小管内闭塞性红细胞管型显著，并伴有周围间质区域的炎症和水肿改变。在调整过度延长的凝血酶原时间后，她的肾功能随着镜下血尿的显著减少而逐渐改善。推测该病例中观察到的急性肾损伤是由于局灶性肾小球肾炎和华法林过量导致肾小球异常出血形成闭塞性红细胞管型所致。因此，本病例提示，在存在并存肾小球损伤的情况下，华法林过量是急性肾损伤的一个潜在危险因素。
