Hemostatic profile in nephrotic syndrome.
OBJECTIVE
To evaluate the coagulation profile and its relation to steroid therapy, and the frequency of thromboembolic complications and its correlation with coagulation parameters in nephrotic syndrome (NS).


METHODS
Hospital based.


METHODS
Forty children with NS were subdivided into four groups, namely, fresh cases, steroid dependent, remission after therapy and steroid resistant. An equal number of age and sex matched children served as controls. In all the study and control subjects, detailed clinical examination, liver function tests, renal function tests and detailed coagulation profile were done. Evaluation of renal veins and inferior vena cava for the presence of thrombosis was also done by abdominal ultrasonography.


RESULTS
Thrombocytosis was detected in 57.5% and the degree of thrombocytosis was directly related to the amount of proteinuria. The mean prothrombin and thrombin times were within normal range in the study children. The activated partial thromboplastine time (APTT) was prolonged in six cases (15%) and three out of these six children had thromboembolic complications. Antithrombin-III level was significantly lower (p < 0.001) whereas protein C and S were significantly elevated (p < 0.001) as compared to controls. The levels became normal with remission of the disease. Steroid therapy significantly increased the levels of proteins C, protein S. AT-III and fibrinogen as compared to controls. Thromboembolic complications were seen in 3 cases (7.6%) and were associated with very low levels of AT-III and protein C and all three had serum albumin below 2 g/dl.


CONCLUSIONS
The importance of coagulation profile in nephrotic syndrome is highlighted and a high index of suspicion for thromboembolic complications is warranted in patients with thrombocytosis, hyper fibrinogenemia, prolonged APTT and in children with low levels of AT-III, protein C and protein S.
Anand
N K
NK
Department of Pediatrics, Safdarjang Hospital, New Delhi.
Chand
G
G
Talib
V H
VH
Chellani
H
H
Pande
J
J
D000990:Antithrombin III / Q000032:analysis; D001777:Blood Coagulation / Q000187:drug effects / Q000502:physiology*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004351:Drug Resistance; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006487:Hemostasis / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D007223:Infant; D007668:Kidney / Q000503:physiopathology; D008099:Liver / Q000503:physiopathology; D008297:Male; D009404:Nephrotic Syndrome / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology*; D010314:Partial Thromboplastin Time; D011486:Protein C / Q000032:analysis; D017293:Protein S / Q000032:analysis; D011507:Proteinuria / Q000209:etiology; D011517:Prothrombin Time; D012074:Remission Induction; D012082:Renal Veins / Q000000981:diagnostic imaging; D012709:Serum Albumin / Q000032:analysis; D013256:Steroids / Q000627:therapeutic use; D013918:Thrombin Time; D013922:Thrombocytosis / Q000209:etiology; D013923:Thromboembolism / Q000209:etiology; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology; D014463:Ultrasonography; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging
D011486:Protein C; D017293:Protein S; D012709:Serum Albumin; D013256:Steroids; D000990:Antithrombin III; D005340:Fibrinogen