Acute and chronic nephropathy induced by fluindione must be addressed.

Abstract

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.

• Authors: Gérard Cam, Angèle Tchiango Kwetcheu, Cécile Vigneau, Pascale Siohan, Guillaume Queffeulou, Philippe Gatault, Eric Laruelle, Alain Crémault, Philippe Le Cacheux, Nathalie Rioux-Leclercq, Eric Renaudineau
• Journal: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association (Nephrol Dial Transplant) Vol. 27 Issue 4 Pg. 1554-8 (Apr 2012) ISSN: 1460-2385 [Electronic] England
• PMID: 21931126 (Publication Type: Journal Article, Multicenter Study)

Chemical References

• Anticoagulants
• Coumarins
• Vitamin K
• Phenindione
• coumarin
• fluindione

Topics

• Acute Kidney Injury (chemically induced)
• Adult
• Aged
• Aged, 80 and over
• Anticoagulants (adverse effects)
• Coumarins (chemistry)
• Drug Hypersensitivity
• Female
• Follow-Up Studies
• France
• Glomerular Filtration Rate
• Humans
• Kidney Failure, Chronic (chemically induced)
• Male
• Middle Aged
• Nephritis, Interstitial (chemically induced)
• Phenindione (adverse effects, analogs & derivatives)
• Prognosis
• Retrospective Studies
• Vitamin K (antagonists & inhibitors)