Hypercoagulability risk factors in children with minimal change disease and the protective role of protein-C activity

Area of Science:

• Pediatric Nephrology
• Hematology
• Thrombosis Research

Background:

• Nephrotic syndrome involves plasma factor imbalance, leading to thrombotic activity.
• Childhood minimal change disease (MCD) is a common cause of nephrotic syndrome.
• Understanding hypercoagulability in MCD is crucial for managing thrombotic complications.

Purpose of the Study:

• To investigate hypercoagulability risk in children with MCD.
• To identify protective hemostatic mechanisms in MCD patients.
• To analyze procoagulant and anticoagulant factor changes during MCD attacks and remission.

Main Methods:

• Study included 26 children with MCD (during attack and remission) and 33 healthy controls.
• Evaluated prothrombosis parameters, lipids, fibrinogen, platelet count, prothrombin fragments 1+2, thrombin-antithrombin complex, lupus anticoagulant, activated protein-C resistance, and D-dimer.
• Assessed protein-C activity, tissue plasminogen activator, and antiplasmin levels.

Main Results:

• During MCD attacks, prothrombosis markers, lipids, fibrinogen, and platelets significantly increased, indicating hyperviscosity and thrombosis tendency.
• Elevated prothrombin fragments 1+2 and thrombin-antithrombin complex confirmed increased thrombin formation and thrombosis risk.
• Increased D-dimer suggested activation of the fibrinolytic system in response to thrombotic activity.
• Higher protein-C activity and decreased tissue plasminogen activator/antiplasmin indicated protective roles of the fibrinolytic system.

Conclusions:

• Childhood minimal change disease is associated with significant hypercoagulability and increased thrombosis risk during attacks.
• Elevated protein-C activity and fibrinolytic system activation serve as crucial protective mechanisms against thrombosis in MCD.
• Maintaining hemostatic balance is vital for preventing thrombotic events in pediatric nephrotic syndrome.