Warfarin-related nephropathy occurs in patients with and without chronic kidney disease and is associated with an increased mortality rate
Warfarin-related nephropathy occurs in patients with and without chronic kidney disease and is associated with an increased mortality rate
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DOI：
10.1038/ki.2011.44
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发表时间：
2011-07-01
影响因子：
19.6
通讯作者：
Hebert, Lee A.
中科院分区：
文献类型：
--
作者：
Brodsky, Sergey V.;Nadasdy, Tibor;Hebert, Lee A.
慢性肾脏病（CKD）患者的国际标准化比值（INR;用于监测华法林效应的凝血酶原时间比较）急性升高超过3通常与血清肌酐（SC）不明原因的急性升高和CKD加速进展相关。这些患者的一个亚组的肾活检显示红细胞管型导致肾小管阻塞，这似乎是急性肾损伤的主要机制。我们称之为华法林相关性肾病（WRN），以前仅在CKD患者中报告了WRN病例。我们现在评估这种情况是否发生在没有CKD的患者中，其危险因素和后果。在5年期间开始华法林治疗的15，258例患者中，4006例INR超过3，同时测量SC;然而，大数据集排除了个体患者临床评估。如果在INR超过3后1周内SC增加超过0.3mg/dl且无出血记录，则推定诊断为WRN。WRN发生率为整个队列的20.5%，CKD队列的33.0%，非CKD队列的16.5%。其他危险因素包括年龄、糖尿病、高血压和心血管疾病。1年死亡率为31.1%，而无WRN的1年死亡率为18.9%，风险增加65%。因此，WRN可能是高危患者华法林治疗的常见并发症，而CKD使该风险加倍。这些风险的机制尚不清楚。Kidney International（2011）80，181-189; doi：10.1038/ki.2011.44; 2011年3月9日在线发表
An acute increase in the international normalized ratio (INR; a comparison of prothrombin time to monitor the effects of warfarin) over 3 in patients with chronic kidney disease (CKD) is often associated with an unexplained acute increase in serum creatinine (SC) and an accelerated progression of CKD. Kidney biopsy in a subset of these patients showed obstruction of the renal tubule by red blood cell casts, and this appears to be the dominant mechanism of the acute kidney injury. We termed this warfarin-related nephropathy (WRN), and previously reported cases of WRN only in patients with CKD. We now assess whether this occurs in patients without CKD, its risk factors, and consequences. In 15,258 patients who initiated warfarin therapy during a 5-year period, 4006 had an INR over 3 and SC measured at the same time; however, the large data set precluded individual patient clinical assessment. A presumptive diagnosis of WRN was made if the SC increased by over 0.3mg/dl within 1 week after the INR exceeded 3 with no record of hemorrhage. WRN occurred in 20.5% of the entire cohort, 33.0% of the CKD cohort, and 16.5% of the no-CKD cohort. Other risk factors included age, diabetes mellitus, hypertension, and cardiovascular disease. The 1-year mortality was 31.1% with compared with 18.9% without WRN, an increased risk of 65%. Thus, WRN may be a common complication of warfarin therapy in high-risk patients and CKD doubles this risk. The mechanisms of these risks are unclear. Kidney International (2011) 80, 181-189; doi:10.1038/ki.2011.44; published online 9 March 2011