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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.
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Contributor : Hervé De Villemeur Connect in order to contact the contributor
Submitted on : Monday, September 26, 2011 - 11:49:56 AM
Last modification on : Monday, May 30, 2022 - 4:16:03 PM

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Gérard Cam, Angèle Tchiango Kwetcheu, Cécile Vigneau, Pascale Siohan, Guillaume Queffeulou, et al.. Acute and chronic nephropathy induced by fluindione must be addressed.. Nephrology Dialysis Transplantation, Oxford University Press, 2012, 27 (4), pp.1554-8. ⟨10.1093/ndt/gfr500⟩. ⟨inserm-00626456⟩



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