Molecular Markers of Hemostasis Activation in Nephrotic Syndrome

Abstract

Fibrinopeptide A (FPA), a sensitive index of in vivo thrombin activity, β-thromboglobulin (βTG) and platelet factor 4 (PF4), specific markers of platelet intravascular activation, have been measured in plasma by radioimmunoassays in 23 patients with nephrotic syndrome and in 32 normal subjects. FPA concentration was 2.40 ± 1.42 ng/ml (mean ± SD) in nephrotic patients and 1.16 ± 0.58 ng/ml in normal controls (p < 0.001); βTG concentration was 57.9 ± 33.2 ng/ml in nephrotic patients and 25.7 ± 7.4 ng/ml in controls (p < 0.001); PF4 level was not different from controls. These data indicate in vivo blood hypercoagulability and platelet hyperfunction in nephrotic syndrome. Moreover, we have documented a slow in vitro FPA generation pattern (ΔFPA): 0.97 ± 0.51 ng/ml/l0 min; this suggests that thrombin activity is predominantly local.

Thrombus formation and platelet-vessel wall interaction in the nephrotic syndrome under flow conditions

“…In vivo fibrin deposition in nephrotic subjects is also suggested by elevated baseline FPA levels in the present study (Table IVB), as well as in studies by others (35). Fibrin deposition normally increases with lower shear rates and promotes inclusion of RBCs and other cell elements ( 12).…”

Nephrotic Syndrome and Anticoagulant Therapy.

“…Fibrinolytic activity can be monitored by measuring FDP, FDP-E products (FDP-E), oc2 plasmin oc2 plasmin inhibitor complex (PIC) and tissue plasminogen activator (tPA) (9). Plasminogen activator inhibitor-1 (PAI-1) acts as an antifibrinolytic factor.…”

Hemostasis, Platelet Functions, Serotonin and Serum Lipids during Omega-3 Fatty Acid Treatment in Patients with Glomerulonephritis

“…A significant fall in fibrinogen concentration was observed after 6 and 12 months of Trienyl administration, as in the study of Hall et al [14]. Platelet hyperactivity may contribute to the prothrombotic state found in patients with proteinuria (mainly nephrotic range) [2]. Omega-3 polyunsaturated fatty acids are rapidly incorporated into platelets, where they compete with arachidonic acid for the 2-acyl position of membrane phospholipid and as substrate for cyclooxygenase enzyme complex that modulates the production of prothrombotic eicosanoids [18].…”

“…Disturbances in serum lipids, hemostasis and platelet functions are frequent features in some kidney diseases and may contribute to the progression of atherosclerosis with its complications [1, 2]. Recently, attention has been paid to the beneficial effects of fish oil on serum lipids, hemostasis and proteinuria [3, 4].…”