Belčič Mikič Tanja, Kojc Nika, Frelih Maja, Aleš-Rigler Andreja, Večerić-Haler Željka
Department of Nephrology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia.
Institute of Pathology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia.
J Clin Med. 2021 Feb 16;10(4):796. doi: 10.3390/jcm10040796.
Anticoagulant-related nephropathy (ARN) is a form of acute kidney injury that mainly occurs in patients with previously unrecognized glomerular disease in addition to excessive anticoagulation. Since a renal biopsy is not performed in most cases, the diagnosis is often presumptive.
Here, we present the characteristics of a national Slovenian patient cohort with histologically verified ARN, from the first case in 2014 to December 2020, and a review of the current literature (Pubmed database).
In Slovenia, ARN has been detected in 13 patients, seven of whom were treated with coumarins, and others with direct oral anticoagulants. In seven patients, ARN appeared after excessive anticoagulation. As many as 11 patients had underlying IgA nephropathy. Similar to the global data presented here, the pathohistological impairment associated with pre-existing glomerulopathy was mild and disproportionate to the degree of functional renal impairment. The majority of our patients with ARN experienced severe deterioration of renal function associated with histological signs of accompanying acute tubular injury, interstitial edema, and occlusive red blood cell casts. These patients were treated with corticosteroids, which (in addition to supportive treatment and discontinuation of the anticoagulant drug) led to a further improvement in renal function.
Anticoagulant therapy combined with a pre-existing glomerular injury may lead to ARN. In addition to discontinuation of the anticoagulant and supportive care, corticosteroids, which are currently listed in only a few cases in the world literature, may have a positive influence on the course of treatment. However, the benefits of steroid treatment must be weighed against the risk of complications, especially life-threatening infections.
抗凝相关肾病（ARN）是急性肾损伤的一种形式，主要发生于既往未被识别的肾小球疾病患者，且存在抗凝过度的情况。由于大多数病例未进行肾活检，诊断往往是推测性的。
在此，我们呈现了一组斯洛文尼亚全国性经组织学证实的ARN患者队列的特征，时间跨度从2014年首例病例至2020年12月，并对当前文献（PubMed数据库）进行了综述。
在斯洛文尼亚，已检测出13例ARN患者，其中7例接受香豆素治疗，其他患者接受直接口服抗凝剂治疗。7例患者在抗凝过度后出现ARN。多达11例患者存在潜在的IgA肾病。与本文呈现的全球数据相似，与既往存在的肾小球病相关的病理组织学损伤较轻，与肾功能损害程度不相称。我们大多数ARN患者出现肾功能严重恶化，伴有急性肾小管损伤、间质水肿和闭塞性红细胞管型的组织学表现。这些患者接受了皮质类固醇治疗，这（除了支持治疗和停用抗凝药物外）使肾功能进一步改善。
抗凝治疗联合既往存在的肾小球损伤可能导致ARN。除停用抗凝剂和支持治疗外，皮质类固醇目前在世界文献中仅有少数病例报道，可能对治疗过程有积极影响。然而，类固醇治疗的益处必须与并发症风险，尤其是危及生命的感染风险相权衡。
