Rivaroxaban-related acute kidney injury in a patient with IgA vasculitis

Abstract

Anticoagulants have recently been recognised as a cause of acute kidney injury (AKI). We describe the case of a 75-year-old man with IgA vasculitis and atrial fibrillation treated with rivaroxaban, who presented with macroscopic haematuria and an acute decline in renal function. Two months before referral, he noted palpable purpuric lesions and was diagnosed with IgA vasculitis based on skin biopsy findings; the skin lesion disappeared following treatment with a steroid external preparation. Renal biopsy revealed glomerular haemorrhage and red blood cell casts. Although rivaroxaban was withdrawn, his kidney function worsened and he was started on haemodialysis. His renal function did not recover. To the best of our knowledge, this is the first case of direct oral anticoagulant (DOAC)-related AKI in systemic vasculitis. During DOAC therapy, close monitoring of a patient’s urinalysis results and their renal function may be required for patients with systemic vasculitis to avoid AKI.

Management of Anticoagulant-Related Nephropathy: A Single Center Experience

“…In recent years, warfarin has been partially replaced by direct oral anticoagulants (DOACs), which inhibit thrombin or factor Xa, the key proteases in the coagulation cascade. Recent reports show that, apart from warfarin, DOACs, particularly dabigatran, 85% of which is excreted through the kidneys, are also associated with ARN [ 5 , 6 , 7 ]. We present here a case of ARN related to dabigatran and warfarin, a retrospective analysis of patients with ARN in our country, and a review of the current literature.…”

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.…”

Case report: rivaroxaban related nephropathy

“…There are two other cases of ARN reported in the literature (6,12). In both cases the renal outcome was poor, with the two patients starting chronic hemodialysis, three weeks and three months after the diagnosis (6,12).…”