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Republished case report
Unusual association of diseases/symptoms
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

https://doi.org/10.1136/dtb.2019.230371rep

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    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 …

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    Footnotes

    • Contributors CD: conceived the need to write this case, completed the literature review and drafted the report. WH and JM: completed the critical revision of the report. Final approval of the version to be published was given by JR.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.