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Double Whammy: Pigment Nephropathy and Warfarin-related Nephropathy As Aetiology for Acute Kidney Injury in a Patient With Mechanical Heart Valves
Arvind Conjeevaram1 , *
Priyangani Lohia2
Ravishankar GS2
Mahesha Vankalakunti3
Authors Info & Affiliations
Priyangani Lohia2
Ravishankar GS2
Mahesha Vankalakunti3
Authors Info & Affiliations
The Open Urology & Nephrology Journal
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31 July 2019 •
CASE REPORT
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DOI: 10.2174/1874303X01912010041
Abstract
It is well known that patients with mechanical heart valves may develop sheer stress related hemolysis and consequent pigment related nephropathy. Warfarin Related Nephropathy (WRN) is a relatively new entity and defined as Acute Kidney Injury (AKI) in the setting of an INR of > 3.0 excluding other obvious etiologies. A biopsy diagnosis of WRN is conducted when red blood cell casts are noted filling and blocking the tubules; additionally, glomerular hemorrhage may be observed. We describe a patient with mechanical heart valves on oral anticoagulation who developed both pigment nephropathy and WRN causing AKI.
Keywords: Warfarin, Pigment nephropathy, Hemolysis, Acute kidney injury, Red cell casts, Direct oral anticoagulants.