Idarucizumab for the treatment of dabigatran-related nephropathy

Alsamarrai, A.; Eaddy, Nicola; Curry, Elizabeth

doi:10.1093/ckj/sfaa030

Cited by 3 publications

(1 citation statement)

References 5 publications

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“…10 Interestingly, Alsamarrai et al reported a case of ARN treatment with idarucizumab, a humanized monoclonal antibody, reversing the anticoagulant effect of dabigatran. 53 Before the introduction of idarucizumab in 2015, hemodialysis was the only available specific therapy in dabigatran overload due to a low molecular weight of the drug and weak protein binding. 64 In a recently published study, Galassi et al proposed an algorithm of dabigatran overdose management in patients with eGFR lower than 30 mL/min.…”

Section: Therapeutic Approachmentioning

confidence: 99%

Anticoagulant-related nephropathy: Focus on novel agents. A review

Zakrocka¹,

Załuska²

2022

Adv Clin Exp Med

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Anticoagulant-related nephropathy (ARN) is a novel and not well-studied cause of acute kidney injury (AKI). The prevalence of ARN varies significantly between studies and is estimated at 20% in patients treated with warfarin. Patients with ARN have a significantly higher mortality risk and an increased risk of chronic kidney disease (CKD). Unexplained AKI with hematuria are clinical manifestations of ARN. In most cases, ARN is diagnosed within the first 2 months of anticoagulant therapy, but later ARN occurrence is possible. Among the studied anticoagulants, most data concern warfarin toxicity, whereas cases of ARN caused by direct oral anticoagulants (DOACs) have also been presented. Tubular obstruction by red blood cell casts or hemoglobin and iron tubular toxicity are the postulated mechanisms of ARN. On the molecular level, the inhibition of thrombin and protease-activated receptor-1 (PAR-1), leading to endothelial susceptibility to damage or abnormal protein C endothelial signaling, is suggested to contribute to ARN. Older age, impaired kidney function, hypertension, and diabetes mellitus are the main risk factors for ARN, but their significance may differ between anticoagulants. From therapeutic options, the withdrawal of the anticoagulant and the administration of its antidote, as well as corticosteroids or N-acetylcysteine, are proposed. Since the number of patients with kidney diseases on anticoagulants increases, and DOACs are starting to be more useful in this group of patients, we aim to summarize the pathogenesis, clinical picture and possible ways of treatment of DOAC-induced ARN.

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Section: Therapeutic Approachmentioning

confidence: 99%