Hemostatic profile in nephrotic syndrome

Area of Science:

• Pediatric Nephrology
• Hematology
• Clinical Coagulation

Background:

• Nephrotic syndrome (NS) is associated with an increased risk of thromboembolic events.
• Understanding coagulation abnormalities in NS is crucial for managing complications.
• Steroid therapy is a cornerstone treatment for NS, potentially influencing coagulation parameters.

Purpose of the Study:

• To investigate the coagulation profile in children with nephrotic syndrome.
• To assess the relationship between steroid therapy and coagulation parameters.
• To determine the frequency of thromboembolic complications and their correlation with coagulation status in NS.

Main Methods:

• A hospital-based study involving 40 children with NS, categorized into four groups based on disease status.
• Comparison with an age- and sex-matched control group.
• Comprehensive clinical examination, liver and renal function tests, detailed coagulation profile analysis, and abdominal ultrasonography for thrombosis detection.

Main Results:

• Thrombocytosis was observed in 57.5% of NS patients, correlating with proteinuria severity.
• Activated partial thromboplastin time (APTT) was prolonged in 15% of cases, with a higher incidence of thromboembolic events.
• Significantly lower Antithrombin-III (AT-III) levels (p < 0.001) and elevated protein C and S levels were noted compared to controls.
• Steroid therapy increased levels of proteins C, S, AT-III, and fibrinogen.
• Thromboembolic complications (7.6%) were linked to very low AT-III and protein C levels, particularly in patients with serum albumin < 2 g/dl.

Conclusions:

• Coagulation profile assessment is vital in managing nephrotic syndrome.
• A high index of suspicion for thromboembolic complications is warranted in NS patients presenting with thrombocytosis, hyperfibrinogenemia, prolonged APTT, or low AT-III, protein C, and protein S levels.