Abstract
Background
Vitamin K antagonists (VKA) are the most widely used anticoagulants for the prevention
of thrombotic events. Several renal adverse effects have been associated with the
use of VKA. The main aim of our study was to explore the association between international
normalized ratio (INR) levels and microscopic hematuria in patients with VKA.
Methods
We performed a cross-sectional study of patients treated with VKA that attended the
outpatient clinic for routine INR control. A simple urinalysis was performed on the
day of the INR control and the precise number of red cells in the urine sediment was
quantified. Demographic data, kidney function tests, comorbidities, anticoagulant
dose and concomitant treatment were registered.
Results
A total of 337 patients were included with median INR levels of 2.6 (IQR 2.1–3.3).
11.9% of the patients presented microscopic hematuria (≥14 RBCs/µl). There was a significant
correlation between INR levels and the number of red blood cells in the urine sediment
(r = 0.201, p = 0.024). In the univariate analysis, microscopic hematuria was associated with having
an INR >3.5 (19% vs. 10.2%, p = 0.046), bacteriuria (15.2% vs. 3.6%, p = 0.015), leukocyturia (14.8% vs. 6.6%, p = 0.026), hypertension (16.2% vs. 9.5%, p = 0.053), and the use of renin-angiotensin system (RAS) blockers (6.9% vs. 17.2%,
p = 0.004). Multivariate logistic regression showed an association between microscopic
hematuria and RAS blockade (OR 0.38, CI 95% 0.163-0.886, p = 0.025), independent from INR levels, hypertension, leukocyturia or bacteriuria.
Conclusions
INR overdose was significantly associated with the presence of microscopic hematuria.
RAS blockade is an independent protective factor for the presence of microscopic hematuria
in anticoagulated patients.
Key Indexing Terms
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of the Medical SciencesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Incidence of visible hematuria among antithrombotic agents: a systematic review of over 175,000 patients.Urology. 2018; 114: 27-32https://doi.org/10.1016/j.urology.2017.11.023
- The significance of hematuria in the anticoagulated patient.Arch Intern Med. 1994; 154: 649-652
- Evaluation of asymptomatic microscopic hematuria.Urol Clin North Am. 1998; 25: 661-676https://doi.org/10.1016/s0094-0143(05)70055-0
- Macroscopic hematuria in patients on anticoagulation therapy.Cent Eur J Urol. 2015; 68: 330-333https://doi.org/10.5173/ceju.2015.658
- Microscopic hematuria in school children: epidemiology and clinicopathologic evaluation.J Pediatr. 1979; 95: 676-684https://doi.org/10.1016/s0022-3476(79)80710-6
- Clinical value of renal biopsy in patients with asymptomatic microscopic hematuria with and without low-grade proteinuria.Clin Nephrol. 2004; 62: 267-272https://doi.org/10.5414/cnp62267
- Analysis of renal biopsies performed in children with abnormal findings in urinary mass screening.Acta Paediatr. 2006; 95: 849-853https://doi.org/10.1080/08035250600652005
- Anticoagulant-related nephropathy.J Am Soc Nephrol. 2018; 29: 2787-2793https://doi.org/10.1681/ASN.2018070741
- Acute kidney injury during warfarin therapy associated with obstructive tubular red blood cell casts: a report of 9 cases.Am J Kidney Dis. 2009; 54: 1121-1126https://doi.org/10.1053/j.ajkd.2009.04.024
- N-acetylcysteine ameliorates acute kidney injury but not glomerular hemorrhage in an animal model of warfarin-related nephropathy.Am J Physiol Renal Physiol. 2013; 304: F1421-F1427https://doi.org/10.1152/ajprenal.00689.2012
- Atrial fibrillation and risk of ESRD in adults with CKD.Clin J Am Soc Nephrol. 2016; 11: 1189-1196https://doi.org/10.2215/CJN.10921015
Article info
Publication history
Published online: July 15, 2022
Accepted:
July 11,
2022
Received:
November 20,
2021
Identification
Copyright
© 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.