Información de la revista
Vol. 33. Núm. 3.Mayo 2013
Páginas 0-735
Vol. 33. Núm. 3.Mayo 2013
Páginas 0-735
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Un caso inusual de hematuria glomerular y fracaso renal agudo en un paciente con enfermedad renal crónica durante terapia con warfarina
An unusual cause of glomerular hematuria and acute kidney injury in a chronic kidney disease patient during warfarin therapy
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Clara Santosa, Ana M. Gomesa, Ana Marta Gomesa, Ana Venturaa, Clara Almeidaa, Joaquim Seabraa
a Department of Nephrology, Centro Hospitalar Vila Nova de Gaia, Vila Nova de Gaia, Portugal,
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La warfarina es una causa muy conocida de hematuria macroscópica. Sin embargo, el deterioro de la función renal no ocurre salvo en el caso inusual de gran pérdida de sangre o formación de coágulos que obstruyen el tracto urinario. Recientemente se ha descrito una entidad denominada nefropatía relacionada con la warfarina en la que el fracaso renal agudo es provocado por hemorragia glomerular y obstrucción tubular renal por cilindros de glóbulos rojos. Exponemos el caso de un paciente bajo tratamiento de warfarina con enfermedad renal crónica, hematuria macroscópica e insuficiencia renal aguda. Una biopsia renal mostró una oclusión masiva de túbulos renales por cilindros de glóbulos rojos. Debatimos la posible relación de la terapia con warfarina, la hemorragia intratubular y el fracaso renal agudo.

Palabras clave:
Enfermedad renal crónica
Palabras clave:
Hematuria glomerular
Palabras clave:
Fracaso renal agudo
Palabras clave:
Warfarina

Warfarin is a well-established cause of gross hematuria. However, impaired kidney function does not occur except in the rare instance of severe blood loss or clot formation that obstructs the urinary tract. It has been recently described an entity called warfarin-related nephropathy, in which acute kidney injury is caused by glomerular hemorrhage and renal tubular obstruction by red blood cell casts. We report a patient under warfarin treatment with chronic kidney disease, macroscopic hematuria and acute kidney injury. A renal biopsy showed massive occlusion of renal tubules by red blood cells and casts. The possible relationship of the warfarin therapy, intratubular hemorrhage and acute kidney injury is discussed.

Keywords:
Chronic kidney disease
Keywords:
Glomerular hematuria
Keywords:
Acute kidney injury
Keywords:
Warfarin
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Bibliografía
[1]
Volpi A, Ferrario GM, Giordano F, Antiga G, Battini G, Fabbri C, et al. Acute renal failure due to hypersensitivity interstitial nephritis induced by warfarin sodium. Nephron 1989;52:196. [Pubmed]
[2]
Brodsky SV, Satoskar A, Chen J, Nadasdy G, Eagen JW, Hamirani M, et al. Acute kidney injury during warfarin therapy associated with obstructive tubular red blood cell casts: a report of 9 cases. Am J Kidney Dis 2009;54:1121-6. [Pubmed]
[3]
3.Brodsky SV, Nadasdy T, Rovin BH, Satoskar AA, Nadasdy GM, Wu HM, Bhatt U, Hebert L. Warfarin-related nephropathy occurs in patients with and without chronic kidney disease and is associated with an increased mortality rate. Kidney Int 2011;80:181-9. [Pubmed]
[4]
4.Ware K, Brodsky P, Satoskar AA, Nadasdy T, Nadasdy G, Wu H, et al. Warfarin-related nephropathy modeled by nephron reduction and excessive anticoagulation. J Am Soc Nephrol 2011;22:1856-62. [Pubmed]
[5]
Abt AB, Carroll LE, Mohler JH. Thin basement membrane disease and acute renal failure secondary to gross hematuria and tubular necrosis. Am J Kidney Dis 2000;35:533-6. [Pubmed]
[6]
6.Kabir A, Nadasdy T, Nadasdy G, Hebert LA. An unusual cause of gross hematuria and transient ARF in an SLE patient with warfarin coagulopathy. Am J Kidney Dis 2004;43:757-60. [Pubmed]
[7]
Brodsky SV, Collins M, Park E, Rovin BH, Satoskar AA, Nadasdy G, et al. Warfarin therapy that results in an International Normalization Ratio above the therapeutic range is associated with accelerated progression of chronic kidney disease. Nephron Clin Pract 2010;115:142-6.
[8]
8.Moreno JA, Martín-Cleary C, Gutiérrez E, Rubio-Navarro A, Ortiz A, Praga M et al.  Haematuria: the forgotten CKD factor? Nephrol Dial Transplant 2012;115:142-6.
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