Dabigatran-Induced Acute Interstitial Nephritis: An Important Complication of Newer Oral Anticoagulation Agents

Abstract

Acute kidney injury (AKI) due to an acute interstitial nephritis (AIN) is common and can lead to increased morbidity and mortality. Medications such as antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), proton pump inhibitors (PPI) and rifampin are common offending agents. Anticoagulant-associated AIN is more frequently reported with the use of warfarin; however, only few case reports have reported an association with the use of novel oral anticoagulants (NOACs). Herein, we report the case of a 59-year-old male who developed AKI after initiating dabigatran for the treatment of atrial fibrillation. Laboratory data demonstrated elevated blood urea nitrogen (BUN) of 115 mg/dL (baseline = 35 mg/dL) and serum creatinine (Cr) of 5.06 mg/dL (baseline = 1.3 mg/dL). Urinalysis revealed eosinophiluria. Renal biopsy disclosed diffuse tubulointerstitial nephritis and eosinophils and confirmed the diagnosis of AIN. At 1 week, renal function improved (BUN/Cr = 53/2.73 mg/dL) with steroid therapy and discontinuation of dabigatran. With an increasing use of NOACs, it is important to monitor renal function to diagnose AIN in a timely fashion. Early diagnosis and prompt treatment can mitigate serious renal damage induced by dabigatran.

Management of Anticoagulant-Related Nephropathy: A Single Center Experience

“…Although early administration of steroids has been reported to accelerate recovery from the more classic inflammation observed in drug (anticoagulants)-induced nephritis [ 20 , 21 , 22 , 23 , 24 ], the use of corticosteroids in ARN is still limited to a few reported cases [ 25 , 26 ]. Our decision to treat with steroids was based on clinical judgement and the extent of pathohistological changes associated with acute tubular injury.…”

Direct oral anticoagulant and AKI: apixaban-induced acute interstitial nephritis

“…As the use of DOACs increase, renal complications of DOACs are arising. Studies show DOAC-induced AKI, nephropathy and AIN 3 7 8. Another case report found initiation of treatment with apixaban resulted in aggravation of pre-existing mild AKI 9.…”

“…Apixaban, an oral factor Xa inhibitor, was approved by the Food and Drug Administration in 2014 for the treatment of venous thromboembolic events and stroke prevention in patients with atrial fibrillation. To date, this is the first biopsy proven case of apixaban-induced AIN 3–5…”

Concomitant Use of NSAIDs or SSRIs with NOACs Requires Monitoring for Bleeding

“…Until now, there have been some case reports of NOAC-induced nephropathy. 29 30 Further population-based studies examining the association between potential interacting drugs of NOAC and risk of urinary tract bleeding are needed.…”