인공심장판막 치환술 후 와파린 항응고 치료 중 발생한 급성 신손상 1례

Abstract

A 58-year-old male patient was admitted with the weakness feeling of right upper extremity. The patient, who had been done the replacement of prosthetic mitral and aortic valves 17 years ago, is taking a warfarin to prevent the systemic thromboembolism. On admission, laboratory tests revealed that the prothrombin time international normalized ratio (PT INR) was abnormal as 6.21, serum creatinine level increased to 10.46 mg/dL. The renal biopsy was performed to find the cause of Acute Kidney Injury (AKI). Biopsy Specimens showed the evidence of acute tubular injury and glomerular hemorrhage: red blood cells (RBCs) in Bowman space and numerous occlusive RBC casts in tubules. We experience a case of AKI as a result of the inappropriate warfarin monitoring, which is developed by the glomerular hemorrhage and renal tubular obstruction through RBC casts. We suggest that patients with warfarin therapy need to monitor the kidney function and blood coagulation indicators carefully.