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Warfarin-Related Nephropathy — ESENeph MCQ

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HardAcute Kidney InjuryWarfarin-Related NephropathyESENeph

A 35-year-old man develops acute onset bilateral loin pain, nausea, and AKI (creatinine 350 umol/L) after starting an anticoagulant. He has a history of IgA nephropathy with eGFR previously 55. His INR is 8.5. Urine is haematuric. What has occurred?

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Correct answer: C — Warfarin-related nephropathy (anticoagulant-related nephropathy) – supratherapeutic anticoagulation causes glomerular haemorrhage with tubular obstruction by red cell casts

Warfarin-related nephropathy (WRN) / anticoagulant-related nephropathy (ARN) occurs when supratherapeutic anticoagulation (INR >3-4) causes glomerular haemorrhage in patients with underlying glomerulopathy. Red blood cells fill Bowman's space and form tubular casts, causing AKI. It is particularly associated with IgA nephropathy, diabetic nephropathy, and thin basement membrane disease. Management involves reversing anticoagulation, supportive care, and adjusting the anticoagulation strategy. Permanent GFR loss can occur.

Reference: Brodsky et al 2009 – Warfarin-Related Nephropathy; Moeckel et al 2013