Article Text

Download PDFPDF
Republished: Direct oral anticoagulant and AKI: apixaban-induced acute interstitial nephritis
  1. Christina DiMaria1,
  2. Wael Hanna2,
  3. Julie Murone3,
  4. James Reichart2
  1. 1 Internal Medicine, AlbertEinstein Medical Center, Philadelphia, Pennsylvania, USA
  2. 2 Hospital Medicine, LehighValley Hospital—Cedar Crest, Allentown, Pennsylvania, USA
  3. 3 Medicine, Philadelphia Collegeof Medicine, Philadelphia, Pennsylvannia, USA
  1. Correspondence to Christina DiMaria; dimariac{at}einstein.edu

Statistics from Altmetric.com

In conjunction with BMJ Case Reports, DTB will feature occasional drug-related cases that are likely to be of interest to readers. These will include cases that involve recently marketed drugs for which there is limited knowledge of adverse effects and cases that highlight unusual reactions to drugs that have been marketed for several years.

Summary

Direct oral anticoagulants (DOACs)—dabigatran, rivaroxaban, apixaban and edoxaban—are changing the landscape of clinical practice for patients requiring short and long-term anticoagulation. We report a patient with no history of kidney disease developing acute interstitial nephritis (AIN) after starting a DOAC, apixaban. To date, this is the first biopsy proven case of apixaban-induced AIN.

Background

Direct oral antiCoagulants (DOACs)—dabigatran, rivaroxaban, apixaban and edoxaban—are changing the landscape of clinical practice for patients requiring short and long-term anticoagulation. Since 2009, national trends indicate a rapid adoption of DOACs with their use now matching that of Vitamin-K antagonists (VKA).1 While another study showed that DOACs accounted for 62% of all new anticoagulant prescriptions by mid-2013.2

We report a patient with no history of kidney disease developing acute interstitial nephritis (AIN) after starting a DOAC, apixaban. Apixaban, an oral factor Xa inhibitor, was approved by the Food and Drug Administration in 2014 for the treatment of venous thromboembolic events and stroke prevention in patients with atrial fibrillation. To date, this is the first biopsy proven case of apixaban-induced AIN.3–5

Case presentation

A 70-year-old Caucasian male patient with no known kidney disease (baseline creatinine of 0.84 mg/dL) and medical history of hyperlipidaemia, hypertension and atrial …

View Full Text

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.