Bromadiolone-Induced Severe Acute Kidney Injury reversed by Vitamin K1 administration: Case Report

"Bromadiolone can trigger AKI by causing a severe and prolonged coagulation disorder. However, kidney function may be rapidly restored within days with high-dose vitamin K1 treatment," the researchers stated.

Poison control centers in the United States handle approximately 2.3 million reports of human poisonings each year, with rodenticides responsible for about 0.5% of these cases. Rodenticides encompass a range of substances, including long-acting "superwarfarin" anticoagulants, warfarin, and phosphides, with anticoagulant rodenticides being the most prevalent. Bromadiolone, a commonly used long-acting anticoagulant rodenticide, is known for causing severe coagulation dysfunction. However, there have been no comprehensive reports detailing AKI resulting from bromadiolone poisoning to date.

Buyun Wu, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China, and colleagues described a case of a 27-year-old woman admitted to the hospital with severe coagulopathy and acute kidney injury.

Her coagulation tests revealed a prothrombin time exceeding 120 seconds and an international normalized ratio (INR) greater than 10. Further evaluation of coagulation factors showed markedly reduced levels of factors II, VII, IX, and X, indicating a vitamin K deficiency. The AKI was non-oliguric and accompanied by gross dysmorphic hematuria. The patient's serum creatinine level rose significantly from 0.86 to 6.96 mg/dL. A plasma bromadiolone concentration of 117 ng/mL was detected using gas chromatography/mass spectrometry, suspecting anticoagulant rodenticide poisoning. All other potential causes of AKI were ruled out, except for a horseshoe kidney.

Following the correction of the coagulopathy with high doses of vitamin K and plasma transfusion, the patient's kidney function fully recovered. At a follow-up 160 days post-discharge, coagulation function had normalized, and serum creatinine had decreased to 0.51 mg/dL.

The case indicates that bromadiolone can lead to acute kidney injury (AKI) due to a severe and prolonged coagulation disorder. Unlike other anticoagulant-related nephropathies, kidney function may recover swiftly within days following treatment with a large dose of vitamin K1.

"These findings are significant for clinicians handling coagulopathy in critical care settings. Recognizing the connection between severe coagulation disturbances and AKI could facilitate earlier identification, monitoring, and intervention, ultimately improving patient outcomes. Routine renal function monitoring and prompt correction of coagulation abnormalities should be essential practices in managing patients at risk for AKI," the researchers concluded.

Reference:

Wang, H., Deng, L., Sun, B. et al. Bromadiolone may cause severe acute kidney injury through severe disorder of coagulation: a case report. BMC Nephrol 25, 303 (2024). https://doi.org/10.1186/s12882-024-03746-0