Dear Doctor, I am a 42-year-old male status post aortic valve replacement with St. Jude mechanical valve on anti-coagulation Acitrom 4 mg at 6 p.m. for bicuspid aortic valve with calcific stenosis. For the past few months I was very weak and tired and had off and on diarrhea. When I went to my cardiologist after checking my blood labs he said I have chronic kidney disease stage 5 and started me on hemodialysis. Ultrasound revealed both kidneys are normal in size, shape, position and shoe increased cortical echoes with loss of CMD. Bilateral multiple simple cortical cysts, larged measuring 31 x 34 mm on right side. Right kidney measures 109 mm. Left kidney measures 104 mm. They have not told me the exact cause of CKD. My INR at that time was 4.5. I would like to know that differential diagnosis for cause of my CKD and is there any alternative for Acitrom (Nicoumalone) since they doubt Acitrom induced nephropathy. My sincere thanks in advance for your help in this regard.

I am unable to make a specific diagnosis based on the information that you provide.  In most cases, kidney disease of unknown cause with normal sized kidneys requires a kidney biopsy in order to determine the underlying disease and appropriate treatment.  Since you are on blood thinners (Nicoumalone), this makes a kidney biopsy more risky.  It is sometimes necessary to take a risk in order to know the precise diagnosis and prognosis.  I suggest that you continue to work with your nephrologist and see if there is any chance of performing a kidney biopsy to assist with the diagnosis and treatment.

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