华法林相关肾病_West China Medical Journal

Authors：

王伟 ,  陶冶

四川大学华西医院肾脏内科（成都 610041）;

Corresponding author：

陶冶, Email: tyehuaxi@163.com

Keywords：

华法林; 急性肾损伤; 华法林相关肾病

DOI：

10.7507/1002-0179.20150394

Video：

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华法林相关肾病（WRN）是一种最近被认知的疾病。2009年美国俄亥俄州立大学发现在接受华法林治疗的患者，治疗过程中可以引起急性肾损伤。他们考虑到这种急性肾损伤可能是华法林治疗的一种以前未知的并发症，即WRN。其具体发病机制目前仍未明确，未来针对其具体发病机制仍需要更多的研究。目前一般认为急性肾小管损伤、肾小球毛细血管袢断裂，脱落红细胞阻塞肾小管仍然是WRN 的主要发病机制。动物实验表明维生素K 可以阻止WRN 进展，然而临床上对其仍未有明确的治疗方法。WRN患者的病死率高，故在华法林治疗期间密切监测国际标准化比值及血肌酐值，以便早期诊断及及时治疗。正确的认知WRN 的临床特征，对降低患者病死率和及时的临床干预有重要意义。

Citation： 王伟, 陶冶. 华法林相关肾病. West China Medical Journal, 2015, 30(7): 1365-1368. doi: 10.7507/1002-0179.20150394 Copy

1.	Brodsky SV, Satoskar A, Chen J, et al. Acute kidney injury during warfarin therapy associated with obstructive tubular red blood cell casts:a report of 9 cases[J]. Am J Kidney Dis, 2009, 54(6):1121-1126.
2.	Ware K, Brodsky P, Satoskar AA, et al. Warfarin-related nephropathy modeled by nephron reduction and excessive anticoagulation[J]. J Am Soc Nephrol, 2011, 22(10):1856-1862.
3.	Limdi NA, Beasley TM, Baird MF, et al. Kidney function influences warfarin responsiveness and hemorrhagic complications[J]. J Am Soc Nephrol, 2009, 20(4):912-921.
4.	Ansell J, Hirsh J, Hylek E, et al. Pharmacology and management of the vitamin K antagonists:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)[J]. Chest, 2008, 133(6 Suppl):160S-198S.
5.	Budnitz DS, Shehab N, Kegler SR, et al. Medication use leading to emergency department visits for adverse drug events in older adults[J]. Ann Intern Med, 2007, 147(11):755-765.
6.	Ryan M, Ware K, Qamri Z, et al. Warfarin-related nephropathy is the tip of the iceberg:direct thrombin inhibitor dabigatran induces glomerular hemorrhage with acute kidney injury in rats[J]. Nephrol Dial Transplant, 2014, 29(12):2228-2234.
7.	Cheungpasitporn W, Kaewpoowat Q, Prasidthrathsint K, et al. Warfarin-related nephropathy can be mimicked by an interaction between sulfonamide derivatives and vitamin K antagonists[J]. Kidney, 2011, 80(11):1246.
8.	An JN, Ahn SY, Yoon CH, et al. The occurrence of warfarin-related nephropathy and effects on renal and patient outcomes in korean patients[J]. PLos One, 2013, 8(4):e57661.
9.	Brodsky SV, Nadasdy T, Rovin BH, et al. Warfarin-related nephropathy occurs in patients with and without chronic kidney disease and is associated with an increased mortality rate[J]. Kidney Int, 2011, 80(2):181-189.
10.	Tárnoky AL. Warfarin and albumin[J]. Br Med J (Clin Res Ed), 1982, 285(6344):812.
11.	Tsao SC, Sugiyama Y, Sawada Y, et al. Effect of albumin on hepatic uptake of warfarin in normal and an albuminemic mutant rats:analysis by multiple indicator dilution method[J]. J Pharmacokinet Biopharm, 1986, 14(1):51-64.
12.	Demirkan K, Stephens MA, Newman KP, et al. Response to warfarin and other oral anticoagulants:effects of disease states[J]. South Med J, 2000, 93(5):448-454.
13.	Chang CC, Liou HH, Wu CL, et al. Warfarin slows deterioration of renal function in elderly patients with chronic kidney disease and atrial fibrillation[J]. Clin Interv Aging, 2013(8):523-529.
14.	Limdi NA, Limdi MA, Cavallari L, et al. Warfarin dosing in patients with impaired kidney function[J]. Am J Kidney Dis, 2010, 56(5):823-831.
15.	Yanagita M, Ishii K, Ozaki H, et al. Mechanism of inhibitory effect of warfarin on mesangial cell proliferation[J]. J Am Soc Nephrol, 1999, 10(12):2503-2509.
16.	Yanagita M. Gas6, warfarin, and kidney diseases[J]. Clin Exp Nephrol, 2004, 8(4):304-309.
17.	Coughlin SR. Protease-activated receptors in hemostasis, thrombosis and vascular biology[J]. J Thromb Haemost, 2005, 3(8):1800-1814.
18.	Coughlin SR. Protease-activated receptors in vascular biology[J]. Thromb Haemost, 2001, 86(1):298-307.
19.	Rondeau E, Vigneau U, Berrou J. Role of thrombin receptors in the kidney:lessons from PAR1 knock-out mice[J]. Nephrol Dial Transplant, 2001, 16(8):1529-1531.
20.	Xu Y, Zacharias U, Peraldi MN, et al. Constitutive expression and modulation of the functional thrombin receptor in the human kidney[J]. Am J Pathol, 1995, 146(1):101-110.
21.	Yanagita M. Gas6, warfarin, and kidney diseases[J]. Clin Exp Nephrol, 2004, 8(4):304-309.
22.	Brodsky SV, Collins M, Park E, et al. Warfarin therapy that results in an International Normalization Ratio above the therapeutic range is associated with accelerated progression of chronic kidney disease[J]. Nephron Clin Pract, 2010, 115(2):c142-c146.
23.	Brodsky SV, Nadasdy T, Rovin BH, et al. Warfarin-related nephropathy occurs in patients with and without chronic kidney disease and is associated with an increased mortality rate[J]. Kidney Int, 2011, 80(2):181-189.

1. Brodsky SV, Satoskar A, Chen J, et al. Acute kidney injury during warfarin therapy associated with obstructive tubular red blood cell casts:a report of 9 cases[J]. Am J Kidney Dis, 2009, 54(6):1121-1126.
2. Ware K, Brodsky P, Satoskar AA, et al. Warfarin-related nephropathy modeled by nephron reduction and excessive anticoagulation[J]. J Am Soc Nephrol, 2011, 22(10):1856-1862.
3. Limdi NA, Beasley TM, Baird MF, et al. Kidney function influences warfarin responsiveness and hemorrhagic complications[J]. J Am Soc Nephrol, 2009, 20(4):912-921.
4. Ansell J, Hirsh J, Hylek E, et al. Pharmacology and management of the vitamin K antagonists:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)[J]. Chest, 2008, 133(6 Suppl):160S-198S.
5. Budnitz DS, Shehab N, Kegler SR, et al. Medication use leading to emergency department visits for adverse drug events in older adults[J]. Ann Intern Med, 2007, 147(11):755-765.
6. Ryan M, Ware K, Qamri Z, et al. Warfarin-related nephropathy is the tip of the iceberg:direct thrombin inhibitor dabigatran induces glomerular hemorrhage with acute kidney injury in rats[J]. Nephrol Dial Transplant, 2014, 29(12):2228-2234.
7. Cheungpasitporn W, Kaewpoowat Q, Prasidthrathsint K, et al. Warfarin-related nephropathy can be mimicked by an interaction between sulfonamide derivatives and vitamin K antagonists[J]. Kidney, 2011, 80(11):1246.
8. An JN, Ahn SY, Yoon CH, et al. The occurrence of warfarin-related nephropathy and effects on renal and patient outcomes in korean patients[J]. PLos One, 2013, 8(4):e57661.
9. Brodsky SV, Nadasdy T, Rovin BH, et al. Warfarin-related nephropathy occurs in patients with and without chronic kidney disease and is associated with an increased mortality rate[J]. Kidney Int, 2011, 80(2):181-189.
10. Tárnoky AL. Warfarin and albumin[J]. Br Med J (Clin Res Ed), 1982, 285(6344):812.
11. Tsao SC, Sugiyama Y, Sawada Y, et al. Effect of albumin on hepatic uptake of warfarin in normal and an albuminemic mutant rats:analysis by multiple indicator dilution method[J]. J Pharmacokinet Biopharm, 1986, 14(1):51-64.
12. Demirkan K, Stephens MA, Newman KP, et al. Response to warfarin and other oral anticoagulants:effects of disease states[J]. South Med J, 2000, 93(5):448-454.
13. Chang CC, Liou HH, Wu CL, et al. Warfarin slows deterioration of renal function in elderly patients with chronic kidney disease and atrial fibrillation[J]. Clin Interv Aging, 2013(8):523-529.
14. Limdi NA, Limdi MA, Cavallari L, et al. Warfarin dosing in patients with impaired kidney function[J]. Am J Kidney Dis, 2010, 56(5):823-831.
15. Yanagita M, Ishii K, Ozaki H, et al. Mechanism of inhibitory effect of warfarin on mesangial cell proliferation[J]. J Am Soc Nephrol, 1999, 10(12):2503-2509.
16. Yanagita M. Gas6, warfarin, and kidney diseases[J]. Clin Exp Nephrol, 2004, 8(4):304-309.
17. Coughlin SR. Protease-activated receptors in hemostasis, thrombosis and vascular biology[J]. J Thromb Haemost, 2005, 3(8):1800-1814.
18. Coughlin SR. Protease-activated receptors in vascular biology[J]. Thromb Haemost, 2001, 86(1):298-307.
19. Rondeau E, Vigneau U, Berrou J. Role of thrombin receptors in the kidney:lessons from PAR1 knock-out mice[J]. Nephrol Dial Transplant, 2001, 16(8):1529-1531.
20. Xu Y, Zacharias U, Peraldi MN, et al. Constitutive expression and modulation of the functional thrombin receptor in the human kidney[J]. Am J Pathol, 1995, 146(1):101-110.
21. Yanagita M. Gas6, warfarin, and kidney diseases[J]. Clin Exp Nephrol, 2004, 8(4):304-309.
22. Brodsky SV, Collins M, Park E, et al. Warfarin therapy that results in an International Normalization Ratio above the therapeutic range is associated with accelerated progression of chronic kidney disease[J]. Nephron Clin Pract, 2010, 115(2):c142-c146.
23. Brodsky SV, Nadasdy T, Rovin BH, et al. Warfarin-related nephropathy occurs in patients with and without chronic kidney disease and is associated with an increased mortality rate[J]. Kidney Int, 2011, 80(2):181-189.

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华法林相关肾病

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