Un caso inusual de hematuria glomerular y fracaso renal agudo en un paciente con enfermedad renal crónica durante terapia con warfarina
An unusual cause of glomerular hematuria and acute kidney injury in a chronic kidney disease patient during warfarin therapy
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Sin embargo, el deterioro de la función renal no ocurre salvo en el caso inusual de gran pérdida de sangre o formación de coágulos que obstruyen el tracto urinario. Recientemente se ha descrito una entidad denominada nefropatía relacionada con la warfarina en la que el fracaso renal agudo es provocado por hemorragia glomerular y obstrucción tubular renal por cilindros de glóbulos rojos. Exponemos el caso de un paciente bajo tratamiento de warfarina con enfermedad renal crónica, hematuria macroscópica e insuficiencia renal aguda. Una biopsia renal mostró una oclusión masiva de túbulos renales por cilindros de glóbulos rojos. Debatimos la posible relación de la terapia con warfarina, la hemorragia intratubular y el fracaso renal agudo.</p>" ] "en" => array:1 [ "resumen" => "<p class="elsevierStylePara">Warfarin is a well-established cause of gross hematuria. However, impaired kidney function does not occur except in the rare instance of severe blood loss or clot formation that obstructs the urinary tract. It has been recently described an entity called warfarin-related nephropathy, in which acute kidney injury is caused by glomerular hemorrhage and renal tubular obstruction by red blood cell casts. We report a patient under warfarin treatment with chronic kidney disease, macroscopic hematuria and acute kidney injury. A renal biopsy showed massive occlusion of renal tubules by red blood cells and casts. The possible relationship of the warfarin therapy, intratubular hemorrhage and acute kidney injury is discussed.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Volpi A, Ferrario GM, Giordano F, Antiga G, Battini G, Fabbri C, et al. Acute renal failure due to hypersensitivity interstitial nephritis induced by warfarin sodium. Nephron 1989;52:196. <a href="http://www.ncbi.nlm.nih.gov/pubmed/2500616" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Brodsky SV, Satoskar A, Chen J, Nadasdy G, Eagen JW, Hamirani M, et al. Acute kidney injury during warfarin therapy associated with obstructive tubular red blood cell casts: a report of 9 cases. Am J Kidney Dis 2009;54:1121-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19577348" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "3.Brodsky SV, Nadasdy T, Rovin BH, Satoskar AA, Nadasdy GM, Wu HM, Bhatt U, Hebert L. Warfarin-related nephropathy occurs in patients with and without chronic kidney disease and is associated with an increased mortality rate. Kidney Int 2011;80:181-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21389969" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:1 [ "itemHostRev" => array:3 [ "pii" => "S0145212614001994" "estado" => "S300" "issn" => "01452126" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "4.Ware K, Brodsky P, Satoskar AA, Nadasdy T, Nadasdy G, Wu H, et al. Warfarin-related nephropathy modeled by nephron reduction and excessive anticoagulation. J Am Soc Nephrol 2011;22:1856-62. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21885669" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Abt AB, Carroll LE, Mohler JH. Thin basement membrane disease and acute renal failure secondary to gross hematuria and tubular necrosis. Am J Kidney Dis 2000;35:533-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10692282" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "6.Kabir A, Nadasdy T, Nadasdy G, Hebert LA. An unusual cause of gross hematuria and transient ARF in an SLE patient with warfarin coagulopathy. Am J Kidney Dis 2004;43:757-60. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15042555" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:1 [ "itemHostRev" => array:3 [ "pii" => "S0145212611000270" "estado" => "S300" "issn" => "01452126" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Brodsky SV, Collins M, Park E, Rovin BH, Satoskar AA, Nadasdy G, et al. 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;115:142-6." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "8.Moreno JA, Martín-Cleary C, Gutiérrez E, Rubio-Navarro A, Ortiz A, Praga M et al.\u{A0} Haematuria: the forgotten CKD factor? Nephrol Dial Transplant 2012;115:142-6." 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| 2022 Abril | 141 | 62 | 203 |
| 2022 Marzo | 75 | 59 | 134 |
| 2022 Febrero | 91 | 48 | 139 |
| 2022 Enero | 93 | 36 | 129 |
| 2021 Diciembre | 114 | 48 | 162 |
| 2021 Noviembre | 115 | 48 | 163 |
| 2021 Octubre | 115 | 56 | 171 |
| 2021 Septiembre | 118 | 68 | 186 |
| 2021 Agosto | 108 | 42 | 150 |
| 2021 Julio | 95 | 44 | 139 |
| 2021 Junio | 88 | 38 | 126 |
| 2021 Mayo | 90 | 41 | 131 |
| 2021 Abril | 265 | 112 | 377 |
| 2021 Marzo | 115 | 37 | 152 |
| 2021 Febrero | 89 | 104 | 193 |
| 2021 Enero | 63 | 24 | 87 |
| 2020 Diciembre | 59 | 28 | 87 |
| 2020 Noviembre | 69 | 25 | 94 |
| 2020 Octubre | 83 | 20 | 103 |
| 2020 Septiembre | 73 | 14 | 87 |
| 2020 Agosto | 57 | 13 | 70 |
| 2020 Julio | 82 | 24 | 106 |
| 2020 Junio | 71 | 22 | 93 |
| 2020 Mayo | 105 | 36 | 141 |
| 2020 Abril | 76 | 28 | 104 |
| 2020 Marzo | 77 | 19 | 96 |
| 2020 Febrero | 91 | 27 | 118 |
| 2020 Enero | 97 | 27 | 124 |
| 2019 Diciembre | 106 | 30 | 136 |
| 2019 Noviembre | 92 | 35 | 127 |
| 2019 Octubre | 72 | 23 | 95 |
| 2019 Septiembre | 110 | 45 | 155 |
| 2019 Agosto | 119 | 38 | 157 |
| 2019 Julio | 85 | 33 | 118 |
| 2019 Junio | 77 | 21 | 98 |
| 2019 Mayo | 69 | 31 | 100 |
| 2019 Abril | 110 | 57 | 167 |
| 2019 Marzo | 71 | 33 | 104 |
| 2019 Febrero | 64 | 31 | 95 |
| 2019 Enero | 47 | 27 | 74 |
| 2018 Diciembre | 103 | 38 | 141 |
| 2018 Noviembre | 141 | 18 | 159 |
| 2018 Octubre | 132 | 28 | 160 |
| 2018 Septiembre | 69 | 16 | 85 |
| 2018 Agosto | 61 | 20 | 81 |
| 2018 Julio | 67 | 16 | 83 |
| 2018 Junio | 56 | 25 | 81 |
| 2018 Mayo | 60 | 10 | 70 |
| 2018 Abril | 66 | 11 | 77 |
| 2018 Marzo | 58 | 12 | 70 |
| 2018 Febrero | 41 | 6 | 47 |
| 2018 Enero | 75 | 14 | 89 |
| 2017 Diciembre | 58 | 15 | 73 |
| 2017 Noviembre | 58 | 11 | 69 |
| 2017 Octubre | 48 | 9 | 57 |
| 2017 Septiembre | 40 | 9 | 49 |
| 2017 Agosto | 52 | 14 | 66 |
| 2017 Julio | 47 | 11 | 58 |
| 2017 Junio | 50 | 13 | 63 |
| 2017 Mayo | 54 | 18 | 72 |
| 2017 Abril | 52 | 9 | 61 |
| 2017 Marzo | 48 | 8 | 56 |
| 2017 Febrero | 40 | 7 | 47 |
| 2017 Enero | 36 | 9 | 45 |
| 2016 Diciembre | 64 | 11 | 75 |
| 2016 Noviembre | 76 | 11 | 87 |
| 2016 Octubre | 87 | 18 | 105 |
| 2016 Septiembre | 124 | 8 | 132 |
| 2016 Agosto | 193 | 2 | 195 |
| 2016 Julio | 195 | 3 | 198 |
| 2016 Junio | 142 | 0 | 142 |
| 2016 Mayo | 183 | 0 | 183 |
| 2016 Abril | 138 | 0 | 138 |
| 2016 Marzo | 130 | 0 | 130 |
| 2016 Febrero | 178 | 0 | 178 |
| 2016 Enero | 162 | 0 | 162 |
| 2015 Diciembre | 174 | 0 | 174 |
| 2015 Noviembre | 147 | 0 | 147 |
| 2015 Octubre | 148 | 0 | 148 |
| 2015 Septiembre | 146 | 0 | 146 |
| 2015 Agosto | 119 | 0 | 119 |
| 2015 Julio | 157 | 0 | 157 |
| 2015 Junio | 98 | 0 | 98 |
| 2015 Mayo | 189 | 0 | 189 |
| 2015 Abril | 39 | 0 | 39 |
| 2015 Febrero | 1635 | 0 | 1635 |
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