Ng Chee Yong, Tan Chieh Suai, Chin Chee Tang, Lim See Lim, Zhu Ling, Woo Keng Thye, Tan Puay Hoon
Department of Renal Medicine, Singapore General Hospital, 20 College Road, Academia, Level 3, Singapore, 169856, Singapore.
National Heart Centre Singapore, Singapore, Singapore.
BMC Nephrol. 2016 Feb 1;17:15. doi: 10.1186/s12882-016-0228-4.
Warfarin related nephropathy is one of the potential complications of warfarin therapy. Despite the well described histological entity, the clinical course and approach to warfarin related nephropathy in patients requiring life-long anticoagulation is however not well described in the literature.
We report the clinical course of a 56 years old Chinese lady who presented with over anti-coagulation and acute kidney injury while on warfarin therapy for permanent atrial fibrillation and mechanical valve replacement. Renal biopsy was performed as the acute kidney injury was persistent despite normalization of the International Normalized Ratio and the diagnosis of warfarin related nephropathy was made. Temporary interruption of anti-coagulation, in combination with oral N-acetylcysteine resulted in subsequent stabilization of renal function.
The diagnosis of warfarin induced nephropathy should be considered in patients presenting with unexplained acute kidney injury and over anti-coagulation. Awareness of this clinical entity is important for clinician managing anti-coagulation therapy and renal function should be monitored regularly in patients who are on warfarin therapy.
华法林相关肾病是华法林治疗的潜在并发症之一。尽管其组织学特征已有详尽描述，但对于需要长期抗凝治疗的患者，华法林相关肾病的临床病程及处理方法在文献中描述并不充分。
我们报告了一名56岁中国女性的临床病程，该患者因永久性房颤和机械瓣膜置换接受华法林治疗时出现抗凝过度及急性肾损伤。尽管国际标准化比值已恢复正常，但急性肾损伤仍持续存在，遂进行了肾活检，并确诊为华法林相关肾病。临时中断抗凝治疗并联合口服N-乙酰半胱氨酸后，肾功能随后得以稳定。
对于出现不明原因急性肾损伤和抗凝过度的患者，应考虑华法林所致肾病的诊断。认识这一临床实体对于管理抗凝治疗的临床医生很重要，接受华法林治疗的患者应定期监测肾功能。
