Tissue factor pathway inhibitor in paediatric patients with nephrotic syndrome

BACKGROUND: Tissue factor pathway inhibitor is an endogenous protease inhibitor that regulates the initiation of the extrinsic coagulation pathway by producing factor Xa-mediated feedback inhibition of the tissue factor/factor VIIa (TF/VIIA) catalytic complex. OBJECTIVES: To evaluate plasma TFPI levels in paediatric patients with nephrotic syndrome and its correlation with disease activity. SUBJECTS AND METHODS: Fifteen nephrotic patients in relapse (proteinuria>40mg/m2/hour, hypoalbuminemia, and edema) before initiating steroid therapy (Group I), and another15 nephrotic patients in remission after withdrawal of steroid therapy (Group II) were compared to 15 age- and sex-matched healthy children (Group III). Besides clinical evaluation and routine laboratory investigations of nephrotic syndrome, tissue factor pathway inhibitor levels in plasma were measured by ELISA. RESULTS: Plasma TFPI level was higher in nephrotic patients during relapse (Group I) and during remission (Group II) [102.53±14.23 and 82.93±3.83ng/ml respectively] compared to that in the control group (62.40 ± 7.53 ng/ml) (p< 0.0001). In children with nephrotic syndrome Plasma TFPI level was higher during relapse (Group I) compared to that in remission (Group II) (p< 0.0001). There was a negative correlation between plasma TFPI level and total protein and serum albumin, and there was a positive correlation between plasma TFPI level and urine protein /creatinine ratio with a statistically significant difference (p< 0.05). CONCLUSION: Nephrotic syndrome was associated with increased level of plasma tissue factor pathway inhibitor in comparison to control group and the increase was more apparent in patients with active disease.