TXA and Kidney Failure – A Hidden Danger?

A recent case study published in BMC Nephrology suggests that Tranexamic acid (TXA), a commonly used antifibrinolytic medication, may contribute to acute bilateral renal cortical necrosis (RCN) in trauma patients. The case of a young woman who developed severe kidney complications after receiving TXA raises concerns about its safety, particularly in individuals with additional risk factors for blood clotting.

Monitoring Absenteeism and Enforcing Discipline

TXA is widely used to control excessive bleeding, especially in cases of postpartum haemorrhage and severe trauma. While it has been proven to reduce mortality in trauma patients, its potential link to kidney damage is not well understood. Though rare, there have been reports of TXA being associated with acute kidney injury (AKI) and the need for dialysis. The extent of kidney recovery varies, with some patients experiencing long-term impairment.

Case Report: Young Woman Develops Severe Kidney Injury

Researchers from the University of Montpellier, France, reported the case of a 24-year-old woman with no prior medical conditions who was admitted to the intensive care unit following a severe car accident. Although her vital signs were stable and there was no significant active bleeding, she was given a 1-gram dose of TXA along with supportive treatment.

Shortly after receiving TXA, her blood pressure dropped, requiring temporary norepinephrine support. Further laboratory tests ruled out conditions such as disseminated intravascular coagulation (DIC) and thrombotic microangiopathy (TMA). However, within 48 hours, she developed acute kidney injury, characterized by anuria (lack of urine output) and rising creatinine levels, leading to the need for dialysis.

Diagnosis and Imaging Findings

A contrast-enhanced CT scan of her kidneys revealed widespread damage, confirming acute bilateral RCN. Some kidney regions, particularly in the subcapsular and juxtamedullary areas, remained functional. Over time, her kidney function partially recovered, and after two months, she no longer required dialysis. However, at a one-year follow-up, her kidney function remained impaired, with an estimated glomerular filtration rate (eGFR) of 40 ml/min/1.73 m², indicating chronic kidney damage.

The Role of TXA in Kidney Damage

The researchers highlighted that while TXA is beneficial in reducing mortality from trauma-related bleeding, its potential prothrombotic effects should not be overlooked. In this case, TXA may have contributed to kidney damage since the patient had only mild bleeding and stable blood circulation. Additionally, she was using hormonal contraception, which is known to increase the risk of blood clots, potentially compounding the effects of TXA.

Key Takeaways and Future Considerations

This case underscores the importance of carefully weighing the risks and benefits of TXA in trauma patients, particularly those with additional clotting risks. It also highlights the value of kidney imaging in diagnosing RCN and predicting patient outcomes. Moving forward, further research is needed to establish clear guidelines on the safe use of TXA in non-obstetric bleeding scenarios to minimize the risk of severe kidney complications.

Conclusion

While TXA remains a crucial medication for managing severe bleeding, this case emphasizes the need for caution, especially in patients with other risk factors for clotting. Clinicians should carefully assess the necessity of TXA in each case and monitor kidney function closely to prevent long-term complications.

Source: Inputs from various media Sources

I’m a pharmacist with a strong background in health sciences. I hold a BSc from Delhi University and a pharmacy degree from PDM University. I write articles and daily health news while interviewing doctors to bring you the latest insights. In my free time, you’ll find me at the gym or lost in a sci-fi novel.