Platelet Functions and Coagulation Changes in Indian Children with Nephrotic Syndrome

Abstract

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.

Pituitary adenylate cyclase‐activating polypeptide deficiency associated with increased platelet count and aggregability in nephrotic syndrome

“…Consistent with the literature , the increase in platelet count was less obvious for our INS patients. No correlation between platelet count and plasma PACAP levels was found.…”

“…In our study, the mean value of the urinary protein/creatinine ratio was 136.2 g g –1 in CNS patients vs. 17.8 g g –1 creatinine in INS patients ( P < 0.05), plasma PACAP levels were significantly less reduced in INS patients than in CNS patients (73% vs. 26% of control plasma), and the serum levels of the binding protein ceruloplasmin were severely decreased in CNS patients, whereas they were not altered in INS patients. The fact that the duration of nephrosis before the diagnosis of NS is probably shorter than before could explain why ours and other recent studies could not find significantly increased platelet counts in INS patients . However, the relationship between duration of nephrosis and platelet counts has never been studied.…”

Platelet abnormalities in nephrotic syndrome

“…PLT counts during remission after the start of corticosteroid treatment and early after cessation of corticosteroid treatment remained high [28][29][30][31], while they normalized during long-term remission [29]. Contradicting previous reports, Mittal et al recently described normal PLT counts in Indian nephrotic children [32].…”

“…The majority of studies report increased platelet aggregability, both in adults and children in response to various agonists: ADP [24,25,32,[34][35][36][37], collagen [25,31,32,[35][36][37][38][39], AA [26,34,35] and epinephrine [40], and increased platelet agglutination after stimulation with ristocetin [41] (Table 3). However, other studies could not find increased platelet aggregability in response to collagen [24], AA [25,26,32] and ristocetin [32]. Spontaneous aggregation was observed during NS as well [23-25, 28, 35, 40].…”

Renal Transplantation With Size-Matched End-to-End Venous Anastomosis in Children With Inferior Vena Cava Thrombosis

“…Preoperative evaluation of VCI must certainly be performed in pediatric renal transplant recipients who have such risk factor. For this purpose, either preoperative Doppler ultrasonography or magnetic resonance venography, which might be more appropriate because it is a noninvasive method with high accuracy, can be performed [6,7].…”