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Double whammy: anticoagulant-related nephropathy with leukocytoclastic vasculitis due to warfarin

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Abstract

Anticoagulation-related nephropathy (ARN) is a rare form of acute kidney injury where the use of anticoagulation causes hemorrhage in various compartments of nephron including glomerulus, renal tubules, and interstitial compartment. Also, warfarin-induced vasculitis is an extremely rare condition characterized by the appearance of purpuric lesions on the skin which on biopsy are suggestive of leukocytoclastic vasculitis (LV). We hereby report a case presenting with coexistent warfarin-induced nephropathy and cutaneous vasculitis. A 64-year-old male, on warfarin for 10 years, presented with complaints of palpable purpuric rashes over lower limbs, hematuria, and decrease urine output. INR was in the supratherapeutic range (INR-6.3). Skin biopsy of the lesion was suggestive of LV and kidney biopsy showed RBCs in Bowman’s capsule, RBCs and RBC casts in tubules suggestive of ARN. All vasculitic markers were negative. Thus, a diagnosis of warfarin-induced nephropathy and cutaneous vasculitis was made. Warfarin was discontinued and oral steroids were started. Gradually, his skin lesions improved, and he became dialysis independent. He was then discharged on apixaban. On follow-up after 3 months, his skin lesions had disappeared with partial recovery of kidney function (cr-5.49).

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Authors and Affiliations

  1. Department of Nephrology, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060, India

    Gaurav Bhandari, Vaibhav Tiwari, Anurag Gupta, Vinant Bhargava, Manish Malik, Ashwani Gupta, Anil Kumar Bhalla & D. S. Rana

  2. Department of Pathology, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, India

    Pallav Gupta

Authors
  1. Gaurav Bhandari
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  2. Vaibhav Tiwari
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  3. Anurag Gupta
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  4. Pallav Gupta
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  5. Vinant Bhargava
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  6. Manish Malik
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  7. Ashwani Gupta
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  8. Anil Kumar Bhalla
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  9. D. S. Rana
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Correspondence to Vaibhav Tiwari.

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Bhandari, G., Tiwari, V., Gupta, A. et al. Double whammy: anticoagulant-related nephropathy with leukocytoclastic vasculitis due to warfarin. CEN Case Rep 11, 154–158 (2022). https://doi.org/10.1007/s13730-021-00642-6

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  • DOI: https://doi.org/10.1007/s13730-021-00642-6

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