Effect of corticosteroids on coagulation factors in children with nephrotic syndrome

Voisin²,

et al. 1994

Nephron

Disturbances in hemostatic and hemorheological parameters have been investigated in a group of 29 children with nephrotic syndrome: 23 children classified as steroid-sensitive and 6 as steroid-resistant. Studies were performed before prednisone treatment and 3 weeks later, after initiation of steroid therapy. Before treatment, the alterations in hemostatic system involved moderate thrombocytosis with spontaneous aggregation in 19 patients. High levels of fibrinogen, factor VIII, Willebrand factor, protein C, protein S and α₂-macroglobulin (α₂M) were observed. Factor XII and α₁-antitrypsin (α₁AT) were lower than normal. Antithrombin III (ATIII) level was normal in the majority of patients. A plasma and blood hyperviscosity syndrome was also observed as well as an increase in erythrocyte aggregation. During treatment, an improvement in the hemostatic parameters was observed in the patients who responded to prednisone. The expected increase in factor VIII (frequently described in the literature) was not observed, while there was a significant increase in protein C. In the steroid-resistant patients, the only significant changes observed were decreased fibrinogen and increased protein C. The hemorheological parameters showed a tendency towards normality regardless of whether or not the treatment provided remission of NS. The relationship between hemorheological and hemostatic factors changes are discussed.

Section: Discussionmentioning

confidence: 49%

Hemorheological and Hemostatic Parameters in Children with Nephrotic Syndrome Undergoing Steroid Therapy

Voisin²,

et al. 1994

Nephron

“…Abnormalities in the coagulation cascade have also been reported [20][21]. These include increased levels of the coagulation factors V and VIII, vWF, factor VII and fibrinogen.…”

Section: Discussionmentioning

confidence: 98%

Platelet Functions and Coagulation Changes in Indian Children with Nephrotic Syndrome

Mittal

Aggarwal²,

Saluja³

et al. 2013

JCDR

Introduction: Only little is known on the effect of the platelet function in the paediatric nephrotic syndrome. The earlier studies which had been done on hypercoagulability have mainly featured the secondary forms of the nephrotic syndrome and the data on the minimal change type of disease is limited.We therefore, made an effort to study the platelet functions and the coagulation profile in children with the nephrotic syndrome,to find the relationship between the steroid response and the coagulation profile, and to look for the correlation between thromboembolism and the hypercoagulable states.Methodology: Twenty nine children with the steroid responsive nephrotic syndromewere studied to see the platelet aggregation and the coagulation parameters and their response to the steroid therapy. Doppler studies were done for the renal vein and the inferior vena cava (IVC) thrombus.Results: It was seen that an increased aggregability of the platelets occurred with Adenosine diphosphate (ADP) and collagen (out of the four agonists, ADP, Collagen, Ristocetin and Arachidonic acid) which were used as agonists for the assay.We also observed that the Partial thromboplastin time (PTT) had become prolonged and a significant decline in the high values of the procoagulant proteins (Protein C and Protein S) was seen after the steroid therapy and when the children went into remission. These findings were suggestive of a reversibility of the changes in the steroid responsive nephrotic syndrome with the steroid therapy.One child was found to have thrombosis of the inferior vena cava (IVC) on Doppler studies, which resolved with treatment subsequently.Conclusions: An increased platelet aggregability contributes to the hypercoagulable states, that may increase the incidence of thrombosis in such patients. Although the incidence of such complications is very low, in a given child with the hypercoagulable states, Doppler may be used to look for any evidence of a latent thrombus and, an early intervention could be instituted. A change in the coagulation parameters points to the reversibility of the changes which are produced in a diseased state.

“…The author previously reported an en hancement of plasma coagulation factors induced by steroids in children with the nephrotic syndrome [8]. In the present study, the effect of steroids on some hemo static parameters other than coagulation factors was in vestigated to determine whether steroids could be an additional thrombogenic risk factor in children with min imal change nephrotic syndrome (MCNS).…”

Section: Introductionmentioning

confidence: 99%

“…Several factors have a key role for the thromboembolic events associated with the nephrotic syndrome: (1) thrombocytosis and platelet hyperaggregability [3][4][5], (2) increased levels of fibrinogen [6,7] and coagulation factors [3,8], and (3) reduced fibrinolysis including decreased levels of antithrombin III and plas minogen [9][10][11], as well as increased a 2-antiplasmin which is known to be the major determinant of fibrinolytic inhibitors [3,11,12].…”

Section: Introductionmentioning

confidence: 99%

Effect of Corticosteroids on Some Hemostatic Parameters in Children with Minimal Change Nephrotic Syndrome

Ueda¹

1990

Nephron

Self Cite

Effect of corticosteroids (steroids) on some hemostatic parameters was serially studied in 23 children with minimal change nephrotic syndrome (MCNS). Increased platelet count, erythrocyte sedimentation rate (ESR), cholesterol, fibrinogen, fibrin(ogen) degradation products (FDP), α2-macroglobulin (α2M), α2-antiplasmin (α2AP) and protein C, and reduced antithrombin III (ATIII) and plasminogen (Plg) were noted in relapse before steroid therapy began. With institution of oral prednisolone, FDP started to fall, and platelet count, cholesterol, α2M, ATIII, Plg, α2AP and protein C started to increase despite unchanged nephrotic state from that before the therapy. In remission induced by prednisolone, platelet count, cholesterol, α2M, ATIII, Plg, α2AP and protein C were still increased, but normalized off therapy. ESR, fibrinogen, FDP, α2M and protein C correlated inversely with serum albumin and directly with cholesterol and urine protein excretion. In contrast, ATIII and Plg correlated directly with serum albumin and inversely with cholesterol and urine protein excretion. A direct correlation was only noted between α2AP and the dose of prednisolone. The data indicate that steroids appear to be a thrombogenic factor by accerelating thrombocytosis and hyperlipidemia, and by reducing plasma fibrinolysis in children with MCNS.