Nefrología Vol. 33 Nº 3 Año 2013
Este artículo no dispone de la versión en español
Nefrologia.2013;33:400-3 | doi: 10.3265/Nefrologia.pre2012.Oct.11617

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


a Department of Nephrology, Centro Hospitalar Vila Nova de Gaia, Vila Nova de Gaia, Portugal,
Resumen

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.

Abstract

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.

Key words: Chronic kidney disease, Glomerular hematuria, Acute kidney injury, Warfarin
Palabras Clave: Enfermedad renal crónica, Hematuria glomerular, Fracaso renal agudo, Warfarina
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