Bromadiolone may cause severe acute kidney injury through severe disorder of coagulation: a case report

• Published in: BMC nephrology Vol. 25; no. 1; pp. 303 - 6
• Main Authors: Wang, Han, Deng, Lingling, Sun, Bin, Xing, Changying, Mao, Huijuan, Wu, Buyun
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 12.09.2024; BioMed Central; BMC
• Subjects: 4-Hydroxycoumarins - poisoning; Abdomen; Acute kidney injury; Acute Kidney Injury - chemically induced; Acute renal failure; Adult; Anticoagulant rodenticide; Anticoagulants; Anticoagulants (Medicine); Anticoagulants - adverse effects; Biopsy; Blood; Blood clotting disorders; Blood Coagulation Disorders - chemically induced; Bromadiolone; Case studies; Coagulopathy; Complications and side effects; Creatinine; Dosage and administration; Female; Gas chromatography; Health aspects; Hematuria; Hemoglobin; Hemorrhage; Hospitals; Humans; Kidneys; Mass spectroscopy; Patients; Pharmacology, Experimental; Physiological aspects; Poisoned; Poisoning; Poisons; Prothrombin; Renal function; Risk factors; Rodenticides; Rodenticides - poisoning; Ultrasonic imaging; Urine; Vitamin deficiency; Vitamin K; Vitamin K - therapeutic use; Vitamin K antagonists; China; Poisoned; Anticoagulant rodenticide; Bromadiolone; Acute kidney injury; Vitamin K antagonists; Coagulopathy
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-024-03746-0

Bromadiolone is a wide-use long-acting anticoagulant rodenticide known to cause severe coagulation dysfunction. At present, there have been no detailed reports of acute kidney injury (AKI) resulting from bromadiolone poisoning. A 27-year-old woman was admitted to the hospital due to severe coagulopathy and severe AKI. Coagulation test revealed a prothrombin time exceeding 120 s and an international normalized ratio (INR) greater than 10. Further examination for coagulation factors showed significantly reduced level of factors II, VII, IX and X, indicating a vitamin K deficiency. The AKI was non-oliguric and characterized by gross dysmorphic hematuria. Following the onset of the disease, the patient's serum creatinine rose from 0.86 to 6.96 mg/dL. Suspecting anticoagulant rodenticide poisoning, plasma bromadiolone was identified at a concentration of 117 ng/mL via gas chromatography/mass spectrometry. All other potential causes of AKI were excluded, except for the presence of a horseshoe kidney. The patient's kidney function fully recovered after the coagulopathy was corrected with high doses of vitamin K and plasma transfusion. At a follow-up 160 days post-discharge, the coagulation function had normalized, and the serum creatinine had returned to 0.51 mg/dL. Bromadiolone can induce AKI through a severe and prolonged coagulation disorder. Kidney function can be restored within days following treatment with high-dose vitamin K1.