Recent advances in anticoagulant-related nephropathy: risk factors, peribiopsy and therapeutic anticoagulation

Abstract The concept of anticoagulant-related nephropathy (ARN), first proposed in 2009, manifests as acute kidney injury or the rapid deterioration of chronic kidney disease secondary to anticoagulant therapy. Large numbers of tubular RBCs and/or tubular RBC casts and ATN, without active glomerulonephritis are the main pathological features. The history of anticoagulant drug use and pathological manifestations are the most important characteristics that distinguish it from other renal injuries. ARN is considered rare, with just over 100 cases documented globally, yet its incidence may be underestimated due to limited awareness. This article reviews the epidemiology, risk factors, etiology and pathogenesis, diagnosis and treatment of ARN. New advances in recent years are highlighted, including the relationship between ARN and other kidney diseases, the characteristics of non-vitamin K oral anticoagulants and their effects on renal function, and the complexities of peri-biopsy and therapeutic anticoagulation. To address the critical peri-biopsy management impasse, we evaluated anticoagulation strategies from published case reports. Integrating these empirical insights with established perioperative antithrombotic principles, we propose a synthesized strategy for ARN management during the peri-biopsy and treatment phases, accompanied by a diagnostic flowchart. Given the current reliance on case-level evidence, this review does not intend to issue definitive clinical guidelines. Rather, it aims to build a comprehensive cognitive framework and a structured consideration system, facilitating nuanced assessments to ultimately improve patient outcomes in this challenging clinical domain.