Introduction: Idiopathicnephrotic syndrome (INS) is the most common renal disease among children. INS present with proteinuria, hyperlipidemia, edema, hypoalbuminemia, and hypercoagulability. A serious consequence of INS is arterial and/or venous thromboembolism e.g., deep vein thrombosis (DVT), pulmonary emboli and renal vein thrombosis. This hypercoagulability may be due to urinary loss of small proteins, specifically antithrombin (AT) III, protein C and S. INS children have been observed to develop thrombocytosis and platelet hyper aggregation leading to increased thromboembolic risk.
Aim of the Study: To evaluate the coagulation profile and results of platelet functions during active nephrosis in children with steroid sensitive and steroid resistant INS.
Methods: Thirty-six children with INS were studied.Twenty-four steroid sensitive and 12 steroid resistant patients were evaluated for platelet function and coagulation parameters during active nephrosis (either at presentation or relapse). The study also included 15 healthy age and sex matched children as control.Doppler imaging was done to confirm thromboembolic events.
Results: Thrombo-embolic complications were observed in 14/36 patients, diagnosed both clinically and/or by doppler.Prolonged PTT was observed during active nephrosis, compared to control. Hypoalbuminemia and hyperlipidemia contributed to hypercoagulability. Mean platelet aggregation to ADP and Ristocetin were significantly elevated among both groups (108.3±10.8% and 104.8±13.2% respectively). Levels of ATIII were significantly reduced, further adds to thrombotic risk.
Conclusion: Thromboembolic complications are not uncommon in nephrotic children. Platelet hyperaggregability positively correlated with VTE in INS children and can be a beneficial predictor of thrombosis during active nephrosis especially those past history of VTE.