This is the biopsy of a patient with a mechanical heart valve and acute kidney injury, requiring hemodialysis. What is your diagnosis?
The pictures show extensive RBC casts, focal interstitial hemorrhage, as well as abundant iron deposition. There was underlying IgA nephropathy with no significant activity. The patient was on warfarin and had supratherapeutic INR, making the biopsy findings consistent with anticoagulant nephropathy and hemosiderosis. Hemosiderosis in this case was likely secondary to chronic hemolysis due to the presence of a mechanical heart valve.
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