Retrospective Analysis of a Novel Regimen for the Prevention of Venous Thromboembolism in Nephrotic Syndrome

Medjeral-Thomas, Nicholas; Ziaj, Stela; Condon, Marie; Galliford, Jack; Levy, Jeremy; Cairns, Tom; Griffith, Megan

doi:10.2215/cjn.07190713

Cited by 55 publications

(57 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…According to the current study, RVT did not occur. According to Medjeral-Thomas et al's study incidence of VTE in MN is more than other forms of NS (14). This difference between previous and the present study might be due to the difference between the age of the population, as membranous nephropathy in adults are frequent but not in pediatrics.…”

Section: Discussioncontrasting

confidence: 74%

The Frequency of Thromboembolic Complications in Pediatric Nephrotic Syndrome

et al. 2019

View full text Add to dashboard Cite

Background: Nephrotic syndrome (NS) is a common renal disease in the pediatric population, which can be complicated with venous thromboembolic events. Objectives: In the present study, the researchers evaluated the risk factors of venous thrombotic events in children with nephrotic syndrome. Methods: In this descriptive cross sectional study, the researchers evaluated 43 cases of NS including 35 uncomplicated and eight complicated patients with venous thrombotic events, who were admitted to the nephrology ward of Ali-Asghar Children Hospital from 2011 to 2015. Two groups were matched for age onset of NS. Data were recorded on age, gender, body mass index (BMI), histopathologic varieties of NS, and serum albumin level. Results:The mean age of cases with venous thrombotic events was 7.31 ± 4.1 years. There were six females. Of eight cases with venous thrombotic events, five cases suffered of pulmonary thromboembolism (PTE) and five cases of deep vein thrombosis (DVT).The mean serum albumin level in the thrombotic group was 1.87 ± 0.4 g/dL. The histopathologic results showed two cases of membranous proliferative glomerulonephritis (MPGN), three cases of minimal change disease (MCD) and one case of focal segmental glomerulosclerosis (FSGS). The researchers found significant differences between mean serum albumin level and histopathologic results in the case and control groups. Conclusions: Venous thrombosis and pulmonary emboli are important complications in pediatric NS. The risk of VTE increases with lower serum albumin level. The risk of VTE increases with lower serum albumin level. The researchers suggest the use of antithrombotic agents as prophylaxis in nephrotic patients with serum albumin level of less than 2 g/dL.

show abstract

Section: Discussioncontrasting

confidence: 74%

The Frequency of Thromboembolic Complications in Pediatric Nephrotic Syndrome

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Local responsible clinicians directed the management of hypertension with angiotensin receptor blockers or angiotensin converting enzyme inhibitors and hypercholesterolaemia with statins. Primary venous thromboembolism prophylaxis in the form of subcutaneous low molecular weight heparin while serum albumin was less than 2.0g/dl or aspirin 75mg daily if the serum albumin was 2.0g/dl or more but less than 3.0g/dl 37 . Patients considered to be at high risk of latent tuberculosis were also prescribed isoniazid 150mg daily and pyridoxine 50mg weekly during immunosuppression treatment.…”

Section: Methodsmentioning

confidence: 99%

Randomized, Controlled Trial of Tacrolimus and Prednisolone Monotherapy for Adults with De Novo Minimal Change Disease

Medjeral-Thomas

Lawrence

Condon

et al. 2020

CJASN

Self Cite

View full text Add to dashboard Cite

Background and objectives: Minimal change disease is an important cause of nephrotic syndrome in adults. Corticosteroids are first-line therapy for minimal change disease but a prolonged course of treatment is often required, and relapse rates are high. Patients with minimal change disease are therefore often exposed to high cumulative corticosteroid doses and are at risk of associated adverse effects. This study investigated whether tacrolimus monotherapy without corticosteroids would be effective for the treatment of de novo minimal change disease. Design, setting, participants and measurements: This was a multicenter prospective, open-label, randomized controlled trial involving 6 nephrology units across the UK. Adult patients with first presentation of minimal change disease and nephrotic syndrome were randomized to treatment with either oral tacrolimus at 0.05mg/kg twice daily, or prednisolone at 1mg/kg daily up to 60mg daily. The primary outcome was complete remission of nephrotic syndrome after 8 weeks of therapy. Secondary outcomes included remission of nephrotic syndrome at 16 and 26 weeks, rates of relapse of nephrotic syndrome and changes from baseline renal function. Results: There were no significant differences between the tacrolimus and prednisolone treated cohorts in the proportion of patients in complete remission at 8 weeks, 21 of 25 (84%) for prednisolone and 17 of 25 (68%) for tacrolimus (p=0.32, differences in remission rates were 16% (95% CI-10.5% to 40.1%)), at 16 weeks, 23 of 25 (92%) for prednisolone and 19 of 25 (76%) for tacrolimus (p=0.25, difference in remission rates 16% (95% CI-7.9% to 38.0%)), or at 26 weeks, 23 of 25 (92%) for prednisolone and 22 of 25 (88%) for tacrolimus (p=0.99, difference in remission rates 4% (95% CI-17.4% to 25.4%)). There was no significant difference in relapse rates (17 of 23 (74%) for prednisolone and 16 of 22 (73%) for tacrolimus) for patients in each group who achieved complete remission (p=0.99), or in the time from complete remission to relapse. Conclusion: Tacrolimus monotherapy can be effective alternative treatment for patients wishing to avoid steroid therapy for minimal change disease.

show abstract

“…One prospective study gave prophylactic-dose low molecular weight heparin (enoxaparin 40 mg) to 30 patients with NS, and after a median follow-up of 13 months no thrombi were identified [15]. A further retrospective study from a center in which routine practice is to offer VTE prophylaxis in the form of aspirin if sAlb 20-30 g/l, and prophylactic dose LMWH or low dose warfarin if sAlb <20 g/l, found no VTE in 143 patients established on therapy for >1 week with a median follow-up of 2.9 years [16]. There were 2 episodes of VTE occurring within the first week of treatment and there were 3 episodes of hemorrhage requiring treatment.…”

Section: Discussionmentioning

confidence: 99%

Venous Thromboembolism in Primary Nephrotic Syndrome - Is the Risk High Enough to Justify Prophylactic Anticoagulation?

Rankin

McQuarrie²,

Fox³

et al. 2016

Nephron

View full text Add to dashboard Cite

Background: The reported incidence of venous thromboembolism (VTE) in patients with nephrotic syndrome (NS) varies widely, as does the approach to prophylactic anticoagulation. We aimed to assess the incidence of VTE in patients with primary NS in order to inform a sample size calculation to determine if a future clinical trial will ever be feasible. Methods: All adults undergoing native renal biopsy for NS between 2008 and 2013 yielding a diagnosis of primary glomerulonephritis were identified. Baseline serum albumin, urine protein:creatinine ratio, estimated glomerular filtration rate, date of biopsy and histological diagnosis were recorded. Episodes of objectively verified VTE were identified using the electronic patient record. Sample size calculations were performed based on 2 independent samples with a dichotomous outcome and to achieve a power of 80% and p < 0.05. Results: Two hundred six patients were included of which 60% were male and mean age at biopsy was 55 years (SD 19). Median follow-up was 2.9 years (interquartile range (IQR) 1.6-4.7). Fourteen (6.8%) patients suffered VTE. Median time to diagnosis of VTE from renal biopsy was 36 days (IQR -22 to 178), with 6 VTEs occurring prior to biopsy and 1 during remission. In a total of 270 patient years of NS, there were 7 VTE that could potentially have been avoided if anticoagulation was given for the duration of NS, that is, 2.6% risk per year of NS; this risk was highest for patients with minimal change nephropathy at 13.3% per year of NS, compared to 0.65% per year of NS for those with idiopathic membranous nephropathy. Assuming a 75% reduction in the incidence of VTE with prophylactic anticoagulation, 972 participants would be required for a future clinical trial to have 80% power. Conclusions: Patients with primary NS are at an increased risk of VTE. The timing of VTE means that only half of episodes would be targeted by prophylactic anticoagulation. Given the low frequency of events, a well-powered clinical trial would be challenging to achieve.

show abstract

Retrospective Analysis of a Novel Regimen for the Prevention of Venous Thromboembolism in Nephrotic Syndrome

Cited by 55 publications

References 23 publications

The Frequency of Thromboembolic Complications in Pediatric Nephrotic Syndrome

The Frequency of Thromboembolic Complications in Pediatric Nephrotic Syndrome

Randomized, Controlled Trial of Tacrolimus and Prednisolone Monotherapy for Adults with De Novo Minimal Change Disease

Venous Thromboembolism in Primary Nephrotic Syndrome - Is the Risk High Enough to Justify Prophylactic Anticoagulation?

Contact Info

Product

Resources

About