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[Prophylactic use of concentrated antithrombin III preparation in children with nephrotic syndrome]
T Oikawa1, Y Muramatsu, S Akashi
1Division of Nephrology, Saitama Children's Medical Center, Japan.
Insights
Low antithrombin III levels in nephrotic syndrome contribute to hypercoagulability. Supplementation normalized antithrombin III in most children but did not prevent thrombotic complications like brain infarction.
Area of Science:
- Nephrology
- Hematology
- Pediatrics
Context:
- Nephrotic syndrome is associated with a hypercoagulable state.
- Decreased plasma antithrombin III levels are implicated in this hypercoagulability.
- Understanding the role of antithrombin III is crucial for managing thrombotic risks.
Purpose:
- To investigate the effect of concentrated antithrombin III preparation on the hypercoagulable state in children with nephrotic syndrome.
- To assess whether antithrombin III supplementation prevents thrombotic complications.
Summary:
- Eight children with nephrotic syndrome and low antithrombin III activity (<70%) received concentrated antithrombin III preparation.
- Plasma antithrombin III activity increased to >70% in 7 out of 8 children post-treatment.
- Levels of plasmin-alpha 2 plasmin inhibitor complex and FDP-D dimer did not significantly decrease.
- One patient experienced brain infarction despite treatment.
Impact:
- Antithrombin III supplementation can restore plasma antithrombin III activity in nephrotic syndrome.
- This supplementation may not be sufficient to fully prevent thrombotic events.
- Further research is needed to optimize prophylactic strategies against thrombosis in nephrotic syndrome.
Abstract:
Decreased plasma level of antithrombin III was assumed to be one of the major factors underlying hypercoagulable state in nephrotic syndrome. Concentrated antithrombin III preparation was given to 8 children with nephrotic syndrome with a plasma antithrombin III activity of less than 70%, to evaluate the effect on hypercoagulable state. Plasma antithrombin III activity was elevated to more than 70% in 7 of 8 children after treatment, while plasma levels of plasmin-alpha 2 plasmin inhibitor complex and FDP-D dimer were not significantly decreased. One patient developed brain infarction after the treatment, suggesting that prophylactic administration of concentrated antithrombin III preparation is not fully protective against thrombotic complications in nephrotic syndrome.