Background :Anticoagulation related nephropathy (ARN) is an under diagnosed complication of anticoagulation that is associated with increased renal morbidity and mortality.While warfarin has been in use since 1954, its harmful effects on the kidneys have only recently been fully recognized .ARN is clinically defined as acute kidney injury (AKI) without obvious aetiology in the setting of over anticoagulation .When it is caused by warfarin, it is often associated with supra therapeutic International Normalized Ratio (INR) (more than 3.0) .AIM:this work aimed to early detection of ARN and how to manage it.Patients and methods:This study was carried out in internal medicine department of Benha University Hospitals. where 50 patients on oral anticoagulation suffered from acute kidney injury were selected and subjected to careful history , clinical examination and laboratory investigation after taking their written consents from march 2019 to march 2020.Results:From the 50 patients ARN was observed in 30% of patients (15 patients) .80% of patients were on warfarin and 20%of patients were on dapigatran. 34% of patients were hypertensive, 56% of patients were chronic kidney disease (CKD) and 40% of patients were diabetic .At the start of the study serum creatinine was 1.5± o.5 mg/dl and mean INR was 2.4±0.6 and after starting oral anticoagulants (OACs) mean INR increased to 6.3±1.8 and serum creatinine increased to 2.6±o.8 mg/dl at the first month of follow up then by controlling INR to 2.8±0.4 at the second month serum creatinine decreased to 2± 0.6 mg/dl .Conclusion :ANRshould be suspected in any patients with over anticoagulation and increased serum creatinine and this need rapid intervention to reverse renal injury.