华法林抗凝、肉眼血尿、血清肌酐进行性升高

Warfarin anticoagulation,gross haematuria and progressive renal dysfunction

老年女性患者,生物瓣膜置换术后长期使用华法林抗凝。肾脏疾病病程4月,表现为持续镜下血尿、发作性肉眼血尿,血清肌酐进行性升高,查MPO-ANCA阳性,肾活检符合ANCA相关性肾炎合并Ig A肾病。患者发作肉眼血尿期间存在抗凝过度,停用抗凝剂后尿色转清、肾功能明显改善,考虑同时合并华法林相关肾病。

A 66 year old woman underwent long-term anticoagulation therapy with warfarin due to bioprosthetic heart valve replacement. The renal involvement was noticed 4 months ago, manifesting persistent microscopic hematuria and paroxysmal gross hematuria with simultaneously serum creatinine increasing, in the case of excessive anticoagulation. Blood examination found positive MPO-ANCA and renal biopsy conformed the renal damage of ANCA associated vasculitis, combined with IgA nephropathy. Gross hematuria dissovled after anticoagulant withdrawal and renal function recovered spontaneously. So warfarin associated nephropathy was also considered..