Journal Article

Acute and chronic nephropathy induced by fluindione must be addressed

Gérard Cam, Angèle Tchiango Kwetcheu, Cécile Vigneau, Pascale Siohan, Guillaume Queffeulou, Philippe Gatault, Eric Laruelle, Alain Crémault, Philippe Le Cacheux, Nathalie Rioux-Leclercq and Eric Renaudineau

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 27, issue 4, pages 1554-1558
Published in print April 2012 | ISSN: 0931-0509
Published online September 2011 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfr500
Acute and chronic nephropathy induced by fluindione must be addressed

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Background. Among the vitamin K antagonists (VKA), indanedione-derived VKA is suspected to induce an immunoallergic risk. One indanedione-derived VKA, fluindione, is still being used in France. The aim of this study was to evaluate the contribution of VKA to acute and chronic nephritis.

Methods. Twenty-four cases of biopsy proven acute interstitial nephritis (AIN) were retrospectively selected, based on a first intake of VKA within the previous 12 months as well as an increase of at least 50% of the basal level of serum creatinine. The 24 cases were all treated with fluindione VKA and not with coumarinic VKA.

Results. The subjects studied included 20 men and 4 women, with a mean age of 73.0 ± 9.3 years (range: 44–84). The delay between fluindione introduction and the appearance of an AIN, proven by biopsy when available, was 11.9 ± 6.9 weeks (range: 3–28). Creatinine increased from 123.0 ± 56.4 μmol/L (range: 56–335) at fluindione introduction to 460.7 ± 265.3 μmol/L (range: 109–1200) at the time of AIN discovery. The treatment then consisted of stopping the fluindione and introducing steroids for 21 patients. If a VKA was necessary, fluindione was replaced by a coumarinic VKA. After 6 months, 1 patient died and 15 patients presented severe chronic kidney disease (CKD Stages 4–5). Two patients still required chronic dialysis after 6 months and five patients after 3 years. Patients with pre-existing kidney disease were more prone to develop severe CKD with fluindione.

Conclusion. In this large study, arguments are presented to incriminate fluindione in the induction of acute and chronic nephritis.

Keywords: acute interstitial nephritis; fluindione; vitamin K antagonists

Journal Article.  2204 words.  Illustrated.

Subjects: Nephrology

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