A study of PT, APTT, fibrinogen and urinary protein-creatinine ratio in paediatric patients with nephrotic syndrome

Authors

  • A. Sujatha Rani Department of Biochemistry, Gandhi Medical College, NTR University of Health Sciences, Secunderabad, Andhra Pradesh, India

Keywords:

Paediatric nephrotic syndrome, Fibrinogen, PT, APTT, Protein/creatinine ratio, Thromboembolic disease

Abstract

Background: Nephrotic Syndrome (NS) is very common in children. The typical laboratory finding is high urinary protein creatinine ratio. Apart from it low serum albumin, high cholesterol contribute to hyper coagulable states. Due to this the risk of thromboembolism in both arterial and venous circulation is significant in children and adults. Patients at risk for thromboembolism traditionally have to be screened by ventilation/perfusion scans and Dopplers for the definitive diagnosis of thromboembolic disease. There are several studies performed on adult nephrotic syndrome and thromboembolic events in them worldwide. We wanted to look for simple, affordable tests, that can be performed even when state of the art technology is not available, and can point towards at risk thromboembolic patients.   

Methods: The study was conducted in 17 nephrotic syndrome children in active disease, 13 nephrotic syndrome children in remission and 15 healthy children as controls, all between 4-14 years age group. Study included both male and female children.  

Results: Our results revealed prolonged. APTT in NS with active disease when compared to remission and control groups. High fibrinogen levels in relapse group indicated hypercoagulative state, along with routine parameters such as high cholesterol and low albumin. Both relapse and remission groups had proteinuria, with very high P/C ratio in relapse group, indicating at risk group for thromboembolic complications along with basic coagulation parameters.

Conclusion: We suggest that when there are indications of hypercoagulable state antiplatelet drugs such as a low dose aspirin 75 mg or low dose warfarin may be given as prophylactic treatment for thromboembolic disease. 

References

Llach F. Hypercoagulability, renal vein thrombosis and other thrombotic complications of nephrotic syndrome. Kidney Int. 1985;28:429-39.

Cameron JS. Coagulation and thromboembolic complications in the nephrotic syndrome. Adv Nephrol. 1984;13:75-114.

Andrassy K, Ritz E, Bonner J. Hypercoagulability in the nephritic syndrome. Klin Wochenschr. 1980;58:1029-36.

Kanfer A, Kleinknecht D, Broyer M, Josso F. Coagulation studies in 45 cases of nephrotic syndrome without uremia. Thromb Diathes Haemorr. 1970;24:562-71.

Llach F, Papper S, Massry SG. The clinical spectrum of renal vein thrombosis: acute and chronic. Am J Med. 1979;69:819-27.

Wagoner RD, Stanson AW, Holley K, Winter CS. Renal vein thrombosis and the nephrotic syndrome. Incidence and significance. Kidney Int. 1983;23:368-74.

Farida Ahmed Farid, Ahmed Abdullah Mohammed, Hanaa Mohammed Afifi, Rania Saleh Beltagi. Tissue factor pathway inhibitor in paediatric patients with nephrotic syndrome. SAJCH. 2011 Dec;5(4):107-11.

Robert A, Olmer M, Sampol J, Gugliotra J, Casanova P. Clinical correlation between hypercoagulability and thrombo-embolic phenomena. Kidney Int. 1987;31:830-5.

Cameron JS, Ogg CS, Wass V. The complications of the nephritic syndrome. In: Cameron JS, Glassock RJ, eds. The Nephrotic Syndrome. 1st ed. New York: Marcel Dekker; 1985: 849-920,

Mahmoodi BK, ten Kate MK, Waanders F, Veeger NJ, Brouwer JL, Vogt L, et al. High absolute risks and predictors of venous and arterial thromboembolic events in patients with nephrotic syndrome. Circulation. 2008;117:224-30.

Zwaginga JJ, Koors HA, Sixma JJ, Rabelink AJ. Thrombus formation and platelet vessel wall interaction in the nephritic syndrome under flow conditions. J Clin Invest. 1994.931:204-11.

Remuzzi G, Mecca G, Marches D, Livio M, Da Gaetano U, Donati MB, et al. Platelet hyperaggregability and the nephritic syndrome. Thromb Res. 1979;16:345-54.

Yoshida N, Aoki N. Release of arachidonic acid from human platelets. A key role for the potentiation of platelet aggregability in normal subjects as well as in those with nephritic syndrome. Blood. 1978;52:969-77.

Bennet A, Cameron JS. Platelet hyperaggregability in the nephritic syndrome which is not dependent on arachidonic acid metabolism or on albumin concentration. Clin Nephrol. 1987;27:182-8.

Machleidt C, Metrang T, Starz E, Weber J, Risler T, Kuhlmann U. Multifactorial genesis of enhanced platelet aggregability in patients with nephrotic syndrome. Kidney Int. 1989;36:1119-24.

Jackson CA, Creaves M, Patferson AD, Brown CB, Preston FE. Relationship between platelet aggregation, thromboxane synthesis and albumin concentration in nephrotic syndrome. Br J Haematol. 1982;52:69-75.

Schieppati A, Dodesini P, Benigni A, Massazza M, Mecca G, Remuzzi G, et al. The metabolism of arachidonic acid by platelets in nephrotic syndrome. Kidney Int. 1984;25:671-6.

Rabelink AJ, Hene RJ, Erkelens DW, Joles JA, Koomans HA. Effects of simvastatin and cholestyramine on lipoprotein profile in hyperlipidaemia of nephritic syndrome. Lancet. 1988;2:1335-8.

Cavalho A, Colman RW, Leks RS. Platelet function in hyperlipoproteinemia. N Engl J Med. 1974;290:434-8.

Rabelink AJ, Zwaginga JJ, Sixma JA, Koomars HA. Hyperlipidemia in nephrotic syndrome is a thrombogenic factor. J Am Soc Nephrol. 1991;3:689.

Mcginley E, Lowe GDO, Boulton-Jones M, Forbes CD, Prentice CRM. Blood viscosity and haemostasis in the nephrotic syndrome. Thromb Haemost. 1982;48:27-32.

Ozanne P, Francis RB, Meiselman HJ. Red blood cell aggregation in nephritic syndrome. Kidney Int. 1983;23:519-25.

Bohler T, Linderkamp O, Leo A, Wingen AM, Sci-Iarer K. Increased aggregation with normal surface charge and deformability of red blood cells in children with nephrotic syndrome. Clin Nephrol. 1992;38:119-24.

Gandrille S, Aiach M. Albumin concentration influences fibrinolytic activity in plasma and purified systems. Fibrinolysis. 1990;4:225-32.

Cook NS, Ubben D. Fibrinogen as a major risk factor in cardiovascular disease. Trends Pharmacol Sci. 1991;11:444-51.

Takeda Y, Chen A. Fibrinogen metabolism and distribution in patients with nephrotic syndrome. J Lab Clin Med. 1967;70:678-85.

R. Saxena, V. V. Batra, N. D. Singh. Prothrombotic factors in nephrotic syndrome. Indian J Pathol Microbiol. 2000;43(3):319-23.

Merouani A, Levy E, Mongeau JG, Robitaille P, Lambert M, Delvin EE. Hyperlipidemic profiles during remission in childhood idiopathic nephrotic syndrome. Clin Biochem. 2003;36:571-4.

Al Mugeiren MM, Gader AM, Al Rasheed SA. Coagulopathy of childhood nephrotic syndrome a reappraisal of the role of natural anticoagulants and fibrignolysis. Haemostasis. 1996;26(6):304-10.

Ueda N, Kawaguchi S, Niinomi Y, Nonoda T, Matsumoto J, Ohnishi M, et al. Effect of corticosteroids on coagulation factors in children with nephrotic syndrome. Paediatr Nephrol. 1987;1(3):286-9.

Anand NK, Chand G, Talib VH, Chellani H, Pande J. Hemostatic profile in nephrotic syndrome. Indian Paediatr. 1996;33(12):1005-12.

Ton J. Rabelink, Jaap Jan Zwaginga, Hein A. Koomans, Jan J. Sixma. Thrombosis and haemostasis in renal disease. Kidney Int. 1994;46:287-96.

Citak A, Emre S, Sairin A, Bilge I, Nayir A. Haemostatic problems and thromboembolic complications. Paediatr Nephrol. 2000 Feb;14(2):138-42.

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Published

2017-02-06

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Original Research Articles