Narasimha Krishna Vinay, Warnock David G, Saxena Nakshatra, Rizk Dana V
Division of Nephrology, University of Alabama at Birmingham, ZRB 629, 1530 3rd Ave S, Birmingham, AL, 35294-0007, USA.
Drug Saf. 2015 Jun;38(6):527-33. doi: 10.1007/s40264-015-0290-z.
Anticoagulant-related nephropathy, a recently recognized entity, manifests as unexplained acute kidney injury in the setting of excessive anticoagulation with oral agents. Histologic findings in warfarin-related nephropathy include glomerular hemorrhage and renal tubular obstruction by red blood cells. Affected patients are at increased risk of mortality as well as irreversible kidney injury. Patients with chronic kidney disease are particularly vulnerable to this complication. Similar case reports of anticoagulant-related nephropathy have been linked to the more novel oral anticoagulant, dabigatran. Anticoagulant-related nephropathy has been successfully reproduced in rat models. These animal models shed light on the pathogenesis of the disease including the potential role of direct thrombin and protease-activated receptor-1 inhibition. Warfarin and dabigatran also cause an increase in systolic blood pressure in rats, a risk factor for developing nephropathy. This article reviews the current evidence for anticoagulant-related nephropathy and provides data for the suggested possible mechanisms underlying this adverse effect.
抗凝相关肾病是一种最近才被认识的疾病，表现为在口服抗凝剂过度抗凝情况下出现的不明原因急性肾损伤。华法林相关肾病的组织学表现包括肾小球出血和红细胞导致的肾小管阻塞。受影响的患者死亡风险以及不可逆转的肾损伤风险增加。慢性肾病患者尤其易患这种并发症。类似的抗凝相关肾病病例报告与更新的口服抗凝剂达比加群有关。抗凝相关肾病已在大鼠模型中成功复制。这些动物模型揭示了该疾病的发病机制，包括直接凝血酶和蛋白酶激活受体-1抑制的潜在作用。华法林和达比加群还会使大鼠收缩压升高，这是发生肾病的一个风险因素。本文综述了目前关于抗凝相关肾病的证据，并提供了关于这种不良反应潜在机制的数据。
