Warfarin-related Nephropathy: Possible Role for the Warfarin Pharmacogenetic Profile

Overview

Journal Clin Kidney J

Publisher Oxford University Press

Specialty Nephrology

Date 2015 Apr 11

PMID 25859382

Citations 7

Authors

Vittorio Di Maso

Michele Carraro

Elena Bevilacqua

Sergio Bucconi

Mary Louise Artero

Giuliano Boscutti

Affiliations

Soon will be listed here.

Abstract

Warfarin-related nephropathy (WRN) is a renal complication of warfarin treatment associated with over-anticoagulation. We describe a case of a 73-year-old man affected by chronic kidney disease, essential hypertension and atrial fibrillation treated with warfarin. The patient presented a rapid course of kidney failure after many episodes of over-anticoagulation, and renal biopsy demonstrated WRN. Interestingly, the patient's warfarin pharmacogenetic profile showed that he was warfarin sensitive. This is the first report describing the presence of gene polymorphisms affecting warfarin metabolism in a subject with a biopsy-proven WRN. The patient was treated with corticosteroids obtaining a partial clinical response.

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References

Kimmel S, French B, Kasner S, Johnson J, Anderson J, Gage B . A pharmacogenetic versus a clinical algorithm for warfarin dosing. N Engl J Med. 2013; 369(24):2283-93. PMC: 3942158. DOI: 10.1056/NEJMoa1310669. View

Brodsky S, Nadasdy T, Rovin B, Satoskar A, Nadasdy G, Wu H . Warfarin-related nephropathy occurs in patients with and without chronic kidney disease and is associated with an increased mortality rate. Kidney Int. 2011; 80(2):181-9. PMC: 3675881. DOI: 10.1038/ki.2011.44. View

Ware K, Brodsky P, Satoskar A, Nadasdy T, Nadasdy G, Wu H . Warfarin-related nephropathy modeled by nephron reduction and excessive anticoagulation. J Am Soc Nephrol. 2011; 22(10):1856-62. PMC: 3279947. DOI: 10.1681/ASN.2010101110. View

Schwarz U, Ritchie M, Bradford Y, Li C, Dudek S, Frye-Anderson A . Genetic determinants of response to warfarin during initial anticoagulation. N Engl J Med. 2008; 358(10):999-1008. PMC: 3894627. DOI: 10.1056/NEJMoa0708078. View

Ozcan A, Ware K, Calomeni E, Nadasdy T, Forbes R, Satoskar A . 5/6 nephrectomy as a validated rat model mimicking human warfarin-related nephropathy. Am J Nephrol. 2012; 35(4):356-64. PMC: 3487141. DOI: 10.1159/000337918. View

Brodsky S, Satoskar A, Chen J, Nadasdy G, Eagen J, Hamirani M . 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(6):1121-6. DOI: 10.1053/j.ajkd.2009.04.024. View

Rubboli A, Becattini C, Verheugt F . Incidence, clinical impact and risk of bleeding during oral anticoagulation therapy. World J Cardiol. 2011; 3(11):351-8. PMC: 3224868. DOI: 10.4330/wjc.v3.i11.351. View

Brodsky S, Collins M, Park E, Rovin B, Satoskar A, Nadasdy G . 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(2):c142-6. PMC: 3696377. DOI: 10.1159/000312877. View

Johnson J, Gong L, Whirl-Carrillo M, Gage B, Scott S, Stein C . Clinical Pharmacogenetics Implementation Consortium Guidelines for CYP2C9 and VKORC1 genotypes and warfarin dosing. Clin Pharmacol Ther. 2011; 90(4):625-9. PMC: 3187550. DOI: 10.1038/clpt.2011.185. View

10.

Moreno J, Martin-Cleary C, Gutierrez E, Toldos O, Blanco-Colio L, Praga M . AKI associated with macroscopic glomerular hematuria: clinical and pathophysiologic consequences. Clin J Am Soc Nephrol. 2011; 7(1):175-84. DOI: 10.2215/CJN.01970211. View

11.

Abt A, Carroll L, Mohler J . Thin basement membrane disease and acute renal failure secondary to gross hematuria and tubular necrosis. Am J Kidney Dis. 2000; 35(3):533-6. DOI: 10.1016/s0272-6386(00)70209-5. View

12.

Limdi N, Beasley T, Baird M, Goldstein J, McGwin G, Arnett D . Kidney function influences warfarin responsiveness and hemorrhagic complications. J Am Soc Nephrol. 2009; 20(4):912-21. PMC: 2663833. DOI: 10.1681/ASN.2008070802. View

13.

Yang J, Chen Y, Li X, Wei X, Chen X, Zhang L . Influence of CYP2C9 and VKORC1 genotypes on the risk of hemorrhagic complications in warfarin-treated patients: a systematic review and meta-analysis. Int J Cardiol. 2013; 168(4):4234-43. DOI: 10.1016/j.ijcard.2013.07.151. View

14.

An J, Ahn S, Yoon C, Youn T, Han M, Kim S . The occurrence of warfarin-related nephropathy and effects on renal and patient outcomes in korean patients. PLoS One. 2013; 8(4):e57661. PMC: 3613349. DOI: 10.1371/journal.pone.0057661. View

15.

Logan I, Sheerin N . Anticoagulation and kidney injury: rare observation or common problem?. J Nephrol. 2013; 26(4):603-5. DOI: 10.5301/jn.5000292. View