Munawar Tooba, Ibe Uzochukwu, Jiwa Nasheena, Raissi Sina
Internal Medicine, St. Mary's Hospital, Waterbury, Connecticut, USA.
Nephrology, St. Mary's Hospital, Waterbury, Connecticut, USA.
BMJ Case Rep. 2019 Aug 21;12(8):e230314. doi: 10.1136/bcr-2019-230314.
A 73-year-old man presented for evaluation of weakness and black tarry stools that occurred 1 day prior to admission. His medical history is significant for diabetes mellitus, stage 3 chronic kidney disease and deep vein thrombosis on warfarin. He was admitted to the hospital and was found to have acute kidney injury and gastrointestinal bleeding due to a supratherapeutic International Normalized Ratio. His hospital course was complicated by persistent decline in his renal function. He was given intravenous fluid resuscitation, fresh frozen plasma and packed red blood cells for his acute blood loss anaemia. Urinalysis was consistent with acute tubular necrosis. Given the persistent rise in creatinine, a kidney biopsy was obtained, and was significant for mild inflammatory changes, without evidence of vasculitis or allergic interstitial nephritis. Histopathological examination with tissue fixation revealed cholesterol embolisation. Given that he had no recent endovascular procedure or instrumentation, this atheroembolic event was attributed to his warfarin use.
一名73岁男性因入院前1天出现的乏力及黑便前来评估。他有糖尿病、3期慢性肾脏病病史，正在服用华法林治疗深静脉血栓。他入院后被发现因国际标准化比值超治疗范围而出现急性肾损伤和胃肠道出血。他的住院过程因肾功能持续下降而复杂化。他因急性失血性贫血接受了静脉补液复苏、新鲜冰冻血浆和浓缩红细胞治疗。尿液分析结果与急性肾小管坏死一致。鉴于肌酐持续升高，进行了肾活检，结果显示有轻度炎症改变，无血管炎或过敏性间质性肾炎证据。组织固定后的组织病理学检查显示有胆固醇栓塞。鉴于他近期未进行血管内操作或器械检查，这一动脉粥样硬化栓塞事件被归因于他使用华法林。
