acenocoumarol and Acute-Kidney-Injury

Anticoagulant-related nephropathy is a type of acute kidney injury caused by overcoagulation. We describe a case of an 84-year-old man with arterial hypertension, coronary heart disease and atrial fibrillation treated with acenocoumarol, who presented with haematoproteinuria and acute kidney injury during a phase of excessive anticoagulation. In addition to IgA nephropathy, renal biopsy also revealed acute tubular necrosis, red blood cell casts and positive iron staining in tubular cells. After this acute episode, renal function improved and proteinuria decreased below the nephrotic range.

Topics: Acenocoumarol; Acute Kidney Injury; Aged, 80 and over; Anticoagulants; Glomerulonephritis, IGA; Humans; Kidney Tubular Necrosis, Acute; Male

Topics: Acenocoumarol; Acute Kidney Injury; Aged; Anticoagulants; Aortic Aneurysm, Abdominal; Embolism, Cholesterol; Humans; Kidney; Male; Pulmonary Embolism

Cutaneous necrosis is an infrequent complication of coumarin therapy. Skin necrosis has usually been reported in patients with congenital protein C deficiency or, less commonly, protein S deficiency. However, this complication may also occur with acquired and transient protein C and/or S deficiency. In coumarin therapy there is a relatively hypercoagulable state at the start of treatment, and most lesions appear between the third and sixth days. We describe a 75-year-old man receiving coumarin therapy (acenocumarol) for 7 years who was given a nonsteroidal anti-inflammatory agent (diclofenac) for a pain in his knee. Two days later, his renal function deteriorated and skin necrosis became evident. Biopsy showed histological changes consistent with coumarin-induced necrosis. Protein C and S levels were normal. We concluded that in our patient acute renal insufficiency aggravated by diclofenac treatment probably associated with an inadvertent withdrawal could have been the precipitating factor for transient protein C deficiency.

Topics: Acenocoumarol; Acute Kidney Injury; Aged; Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Diclofenac; Humans; Leg Dermatoses; Male; Skin

Topics: Acenocoumarol; Acute Kidney Injury; Aged; Anticoagulants; Aorta, Abdominal; Arterial Occlusive Diseases; Bed Rest; Combined Modality Therapy; Female; Femoral Artery; Heparin, Low-Molecular-Weight; Humans; Iliac Vein; Lumbar Vertebrae; Pulmonary Embolism; Remission Induction; Renal Artery; Renal Dialysis; Spinal Fractures; Thrombectomy; Thrombosis; Venous Insufficiency