Anticoagulant-related nephropathy is an increasingly recognized entity, characterized by the presence of hematuria in the context of a supratherapeutic international normalized ratio with the development of secondary acute kidney injury, which may require renal replacement therapy and may progress to chronic kidney disease. We present the case of a 63-year-old patient who started anticoagulant therapy with acenocoumarol 2 months after her kidney transplant and presented with graft dysfunction concomitant to a supratherapeutic international normalized ratio.