Abstract

It has been suggested that the thromboembolic tendency of nephrotic patients is related to changes of levels of coagulation factors, protein C, protein S, antithrombin III, platelet count and functions. The aim of this study was to evaluate the factors contributing to hypercoagulability state and the effect of treatment in nephrotic children. This study comprises a total of 24 patients with nephrotic syndrome, aged 2-13 years (mean age 8.37 3.62 years) of whom 4 is female and 20 is male. Twenty healthy children matched for age and sex with patients were selected as control group. The study population was evaluated for physical examination, sedimentation rate, proteinuria, serum albumin, cholesterol, triglycerid,LDL, HDL, antithrombin III, protein C, protein S, fibrinogen and coagulation factors including factors V, VIII and X. The patients were initially studied during acute phase of their disease and after 8-10 weeks of steroid treatment. Renal biopsy was performed in sixteen patients. Statistical evaluation was made by X2, t tests and correlation analysis. Antithrombin III (60.2±25.3%) and factor X (89.4±21.4%) levels were significantly low in nephrotic patients (P<0.001, P<0.001). Protein C (122.8±26.0%), fibrinogen (589.1±188.4mg/dl), factor VIII (119.7+28.5%) levels and platelet count (430.8±110.4/mm3) were higher than control group (p<0.01). Protein S, factor V, prothrombin time and activated partial thromboplastin levels were not significantly different from normal values (p>0.05). In conclusion, low antithrombin III and high fibrinogen levels are responsible for thromboembolic events in children with nephrotic syndrome. Increased levels of protein C may play some role in the prevention of these complications.