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

Abstract

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.

Systemic lupus erythematosus in a multiethnic US cohort (LUMINA): XXV. Smoking, older age, disease activity, lupus anticoagulant, and glucocorticoid dose as risk factors for the occurrence of venous thrombosis in lupus patients

“…Moreover, Cushing's syndrome is often regarded as a prothrombotic condition (41), since high levels of adrenal steroids have been shown to be associated with several clotting abnormalities, including increased levels of factor VIII, von Willebrand factor, and plasminogen activator inhibitor activity, as well as with decreased fibrinolysis (41)(42)(43). Similar clotting abnormalities have been reported in patients treated with exogenous glucocorticoids (44), indicating that glucocorticoids may, in fact, increase the risk of thrombotic events in individuals with a predisposition to develop them.…”

Cerebral sinovenous thrombosis and idiopathic nephrotic syndrome in childhood: report of four new cases and review of the literature

“…Hyperlipidaemia per se could also be prothrombotic [8]. The contribution of steroids to CSVT risk is controversial [44,50]. Other factors, such as the use of diuretics, haemoconcentration, could also play a role [44].…”

Platelet abnormalities in nephrotic syndrome

“…The relationship between albuminemia and platelet activation markers was further studied. An inverse correlation between serum albumin levels and platelet aggregation, both spontaneous and in response to various aggregation inducers, was found in some studies [23,25,26,39,52], but was not confirmed in others [25,31,35,53].2 Inverse correlations were also observed between serum albumin levels and several markers of platelet activation, such as β-thromboglobulin levels [43,52], PDGF [30], TXB2 generation in response to AA [35] and platelet adhesiveness [23]. Stuart et al found that the net conversion to TXB2 was not dependent on albumin concentration in normal platelets [40].…”

“…A recent article by Scharf provides an overview of drugs known to affect platelet function [77]. The use of corticosteroids in NS can modify some coagulation mechanisms [78,53]. Furthermore, platelets contain a glucocorticoid receptor [79] and prednisolone was found to inhibit platelet function in vitro [80].…”