title: 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.
  
  
  CONCLUSIONS
  In this large study, arguments are presented to incriminate fluindione in the induction of acute and chronic nephritis.
authors.affiliation: Department of Nephrology, Broussais Hospital, Saint-Malo, France.
authors.forename: Gérard
authors.initials: G
authors.lastname: Cam
authors.forename: Angèle Tchiango
authors.initials: AT
authors.lastname: Kwetcheu
authors.forename: Cécile
authors.initials: C
authors.lastname: Vigneau
authors.forename: Pascale
authors.initials: P
authors.lastname: Siohan
authors.forename: Guillaume
authors.initials: G
authors.lastname: Queffeulou
authors.forename: Philippe
authors.initials: P
authors.lastname: Gatault
authors.forename: Eric
authors.initials: E
authors.lastname: Laruelle
authors.forename: Alain
authors.initials: A
authors.lastname: Crémault
authors.forename: Philippe
authors.initials: P
authors.lastname: Le Cacheux
authors.forename: Nathalie
authors.initials: N
authors.lastname: Rioux-Leclercq
authors.forename: Eric
authors.initials: E
authors.lastname: Renaudineau
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D003374:Coumarins / Q000737:chemistry; D004342:Drug Hypersensitivity; D005260:Female; D005500:Follow-Up Studies; D005602:France; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D009395:Nephritis, Interstitial / Q000139:chemically induced*; D010630:Phenindione / Q000009:adverse effects / Q000031:analogs & derivatives*; D011379:Prognosis; D012189:Retrospective Studies; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D003374:Coumarins; D014812:Vitamin K; D010630:Phenindione; C030123:coumarin; C017673:fluindione