Related Experiment Video
Updated: May 15, 2025
Induction of Nephrotic Syndrome in Mice by Retrobulbar Injection of Doxorubicin and Prevention of Volume Retention by Sustained Release Aprotinin
Published on: May 6, 2018
Prophylactic anticoagulation in patients with nephrotic syndrome in the Cure Glomerulonephropathy (CureGN) cohort
Blanca Tarragón1, Heedeok Han1, Mariela Navarro-Torres1
1Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, NY, USA.
Insights
Prophylactic anticoagulation (PAC) is underused in nephrotic syndrome (NS) patients, with management often more conservative than guidelines suggest. Direct oral anticoagulants (DOACs) are increasingly used in adults, despite not being in current guidelines.
Area of Science:
- Nephrology
- Thrombosis research
- Pharmacology
Background:
- Patients with nephrotic syndrome (NS) face elevated risks of thromboembolic events compared to the general population.
- Current use and adherence to prophylactic anticoagulation (PAC) guidelines in NS patients remain largely uncharacterized.
- The 2021 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines provide a framework for PAC management, but practical implementation is unclear.
Purpose of the Study:
- To evaluate thromboprophylaxis strategies in adult and pediatric patients with NS.
- To assess the concordance of current anticoagulation practices with the 2021 KDIGO guidelines.
- To analyze the incidence of thrombotic and bleeding events in this patient cohort.
Main Methods:
- Retrospective analysis of thromboprophylaxis management in NS patients (membranous nephropathy, FSGS, MCD, C1q nephropathy) from the Cure Glomerulonephropathy (CureGN) cohort (2010-2023).
- Assessment of guideline concordance with 2021 KDIGO recommendations for adult patients.
- Analysis of thrombotic and bleeding event rates.
Main Results:
- PAC was prescribed in only 6% of adult and 4% of pediatric NS episodes.
- In adults, PAC use correlated with prior thrombosis, low serum albumin, and high proteinuria; coumarins and direct oral anticoagulants (DOACs) were equally common.
- Guideline concordance was observed in 48% of adult cases, with most discordance (92%) involving undertreatment in high-risk patients; thrombotic events occurred in 1.3% of adults and 1.5% of children.
Conclusions:
- Prophylactic anticoagulation is used more conservatively than KDIGO guidelines suggest, primarily influenced by hypoalbuminemia severity in both age groups.
- Direct oral anticoagulants (DOACs) are frequently used in adults, matching coumarin use, despite not being explicitly mentioned in current guidelines.
- Further research is needed to optimize anticoagulation strategies in nephrotic syndrome to align with evidence-based guidelines and improve patient outcomes.
Background:
Adult and paediatric patients with nephrotic syndrome (NS) due to different glomerular diseases are at a higher risk of thromboembolic events than the general population, but the use of prophylactic anticoagulation (PAC) among them has not been well described. Although the 2021 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines offer an algorithm to guide the management of PAC, the degree of implementation in practice is unknown.
Methods:
We evaluated thromboprophylaxis management in patients with NS secondary to membranous nephropathy, focal segmental glomerulosclerosis, minimal change disease and C1q nephropathy enrolled in the Cure Glomerulonephropathy (CureGN) cohort study (diagnosed 2010-2023) and assessed the concordance or discordance with the 2021 KDIGO guidelines practice points in adults. We also analysed thrombotic and bleeding events.
Results:
Among 374 adult and 263 paediatric NS episodes, PAC was prescribed in 21 (6%) and 11 (4%) episodes, respectively. In adults, PAC prescription was associated with a history of prior thrombosis, lower serum albumin and higher proteinuria, with coumarins and direct oral anticoagulants (DOACs) being equally the most prescribed agents. In adults, anticoagulation management was concordant with guidelines in 180 (48%) episodes, discordant in 59 (16%) and indeterminate in 135 (36%). Most (92%) guideline-discordant episodes were cases with a high thrombotic risk and low bleeding risk where PAC was not prescribed. In children, PAC prescription was associated with lower albuminaemia and worse kidney function, with heparins being the only agent used. Thrombotic events occurred during 5 (1.3%) and 4 (1.5%) of all adult and paediatric NS episodes, respectively.
Conclusions:
PAC was used more conservatively than guidelines suggest and was mainly driven by hypoalbuminaemia severity in both adults and children. Although not included in the guidelines practice points, DOACs were used as often as coumarins in adults.
More Related Videos
08:05Occlusion of the Great and Small Saphenous Vein Using Copolymeric Glue Based on N-Butyl Cyanoacrylate and Methacryloxy Sulfolane
Published on: December 9, 2022
08:505/6th Nephrectomy in Combination with High Salt Diet and Nitric Oxide Synthase Inhibition to Induce Chronic Kidney Disease in the Lewis Rat
Published on: July 3, 2013
Related Concept Videos
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:11Renal Failure: Dose Adjustments
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:20Renal Corpuscle
Glomerulus: Structure and Function
The glomerulus is a tiny, intricate network of capillaries located at the beginning of the nephron. It's enveloped by the Bowman's capsule and receives its blood supply from an afferent arteriole, which divides into numerous...
01:16Antihypertensive Drugs: Action of Diuretics