Acute immuno-allergic interstitial nephritis caused by fluindione.
Fluindione is a vitamin K antagonist that is commonly prescribed for the treatment of cardiovascular disease and venous thromboembolism in France. Bleeding is the most common side effect of fluindione, whereas hypersensitivity reactions are rare. We describe here a patient with acute immuno-allergic interstitial nephritis caused by fluindione. Initial symptoms included fever, eosinophilia, low albuminuria, microscopic hematuria, eosinophiluria and acute renal failure. Kidney biopsy showed severe interstitial nephritis with interstitial edema, inflammatory infiltrates and tubulorrhexis. Fluindione withdrawal and corticosteroid treatment resulted in rapid recovery of renal function. A review of the literature revealed a very low incidence of fluindione-induced interstitial nephritis, with variable renal and extra-renal signs. Early recognition of this rare complication may prevent the development of severe chronic renal injury.
Belmouaz
S
S
Department of Nephrology, Hôpital Jean Bernard, Centre Hospitalier Universitaire, Rue de la Miletrie, BP 577, 86021 Poitiers, France. s.belmouaz@chu-poitiers.fr
Desport
E
E
Abou Ayache
R
R
Thierry
A
A
Mignot
A
A
Bauwens
M
M
Goujon
J M
JM
Bridoux
F
F
Touchard
G
G
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D001706:Biopsy; D003937:Diagnosis, Differential; D004342:Drug Hypersensitivity / Q000276:immunology* / Q000473:pathology; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000648:ultrastructure; D008297:Male; D008854:Microscopy, Electron; D009395:Nephritis, Interstitial / Q000139:chemically induced / Q000276:immunology / Q000473:pathology; D010630:Phenindione / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D020246:Venous Thrombosis / Q000188:drug therapy
D000925:Anticoagulants; D010630:Phenindione; C017673:fluindione