Antithrombin III (AT III) and Fibrinogen Levels in Nephrotic Syndrome in Children

Elidrissy, Abdelwahab T. H.; Gader, A. M. A.

doi:10.1159/000215177

Cited by 9 publications

(13 citation statements)

References 10 publications

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“…Besides, they found plasma antithrombin III (ATIII) concentration to be normal except in focal segmental glomerulosclerosis (FSGS). Our own findings [7] and those of others [10,13,21] have shown that during relapse of nephrosis, plasma ATIII is significantly reduced but returns to normal levels with the onset of remission.…”

Section: Introductionsupporting

confidence: 69%

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Haemostatic measurements in childhood nephrotic syndrome

et al. 1991

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Blood coagulation and platelet aggregation were assessed in children with nephrotic syndrome who were divided into the following groups: (1) relapse without treatment: (2) relapse on steroids; (3) early remission; (4) late remission and (5) steroid resistant. The renal histological findings were also recorded. Plasma anti-thrombin III (ATIII) levels were markedly reduced in groups 1 and 2, below normal in group 3 and were normal in groups 4 and 5. There was significant urinary loss of ATIII in groups 1 and 2 as well as in group 5. Plasma fibrinogen fluctuations exhibited the expected negative correlations with plasma ATIII. Reptilase time showed significant prolongation in groups 1, 2 and 3, and was near normal in groups 4 and 5. Platelet aggregation in response to arachidonic acid exhibited aggregation followed by disaggregation in groups 1, 2, 4 and 5, and was normal in group 3. Hyperaggregation in response to decreasing doses of ADP was noted in all patient groups as well as controls with no relationship to serum albumin levels. Aggregation responses to collagen and ristocetin were normal. It is concluded that: 1. The fluctuations in ATIII levels in childhood nephrotic syndrome are determined by the response to steroids and not by the renal histology per se. 2. An acquired fibrin polymerization defect (dysfibrinogenaemia) and an abnormality of the prostaglandin pathway of platelet activation, both reversible, are yet other haemostatic abnormalities in childhood nephrosis. 3. The discrepancies in the literature on haemostatic parameters, specially ATIII in childhood nephrosis, would not have arisen if their fluctuation in relation to steroid therapy as well as the renal histological features of nephrotic syndrome had been documented simultaneously.

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Section: Introductionsupporting

confidence: 69%

“…Blood samples for coagulation assays and platelet aggregation were collected and processed as already described [4,7]. Methods for prothrombin time, partial thromboplastin time, thrombin time, reptilase time, plasma fibrinogen, ATIII and platelet aggregation were described previously [4,7].…”

Section: Methodsmentioning

confidence: 99%

Haemostatic measurements in childhood nephrotic syndrome

et al. 1991

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“…Both ATIII and protein C are lost in urine during the relapse of nephrosis [4,8,[18][19][20] and the loss of ATIII in urine was taken into account for its low plasma levels during the relapse phase [4,8], When patients go into remission, the urinary protein loss (including ATIII) ceases and ATIII levels normalise.…”

Section: Discussionmentioning

confidence: 99%

Coagulopathy of Childhood Nephrotic Syndrome – A Reappraisal of the Role of Natural Anticoagulants and Fibrinolysis

Al-Mugeiren

Gader²,

Al-Rasheed³

et al. 1996

Pathophysiol Haemos Thromb

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In an attempt to characterise further the coagulopathy of childhood nephrotic syndrome, this study concentrates on simultaneous measurements of the natural anticoagulants [antithrombin III (ATIII), proteins C and S] and the fibrinolytic factors, tissue plasminogen activator (tPA) and plasminogen activator inhibitor (PAI). The study groups consisted of 41 children (ages ranging from 2 to 14 years; median 7.1) in the relapse of nephrosis and 48 children (ages ranging from 3 to 14 years; median 7.6) in remission. The results obtained were compared with normal values obtained in healthy age- and sex-matched controls (n = 103). During relapse, there was a marked increase in the plasma level of fibrinogen, protein C, and protein S and reduced plasma ATIII level; tPA level was similar to control but PAI level exhibited a significant reduction. During remission, the protein C level either remained elevated or increased further, but some decreased. Protein S and plasma ATIII level normalised. The fibrinolytic activator tPA dropped slightly but the PAI level remained significantly below control levels. We conclude that in the relapse of childhood nephrosis, despite the existence of a significant prothrombotic tendency as featured by hyperfibrinogenaemia and markedly reduced ATIII level, the simultaneous elevation of the natural anticoagulant, protein C level and enhanced fibrinolysis that persist until the remission phase, seem to be major preventive mechanisms guarding nephrotic children against thromboembolic phenomena.

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“…However, in 13 children ATIII level was below 8091-and 4 of these children had lower levels than 55%. Reduced ATIII levels appear to be more frequent in children [14,36,[43][44][45][46], However, some authors report ATIII levels within the limits of the normal range [15. 47-491.…”

Section: Discussionmentioning

confidence: 99%

Hemorheological and Hemostatic Parameters in Children with Nephrotic Syndrome Undergoing Steroid Therapy

André

Voisin²,

André

et al. 1994

Nephron

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Disturbances in hemostatic and hemorheological parameters have been investigated in a group of 29 children with nephrotic syndrome: 23 children classified as steroid-sensitive and 6 as steroid-resistant. Studies were performed before prednisone treatment and 3 weeks later, after initiation of steroid therapy. Before treatment, the alterations in hemostatic system involved moderate thrombocytosis with spontaneous aggregation in 19 patients. High levels of fibrinogen, factor VIII, Willebrand factor, protein C, protein S and α₂-macroglobulin (α₂M) were observed. Factor XII and α₁-antitrypsin (α₁AT) were lower than normal. Antithrombin III (ATIII) level was normal in the majority of patients. A plasma and blood hyperviscosity syndrome was also observed as well as an increase in erythrocyte aggregation. During treatment, an improvement in the hemostatic parameters was observed in the patients who responded to prednisone. The expected increase in factor VIII (frequently described in the literature) was not observed, while there was a significant increase in protein C. In the steroid-resistant patients, the only significant changes observed were decreased fibrinogen and increased protein C. The hemorheological parameters showed a tendency towards normality regardless of whether or not the treatment provided remission of NS. The relationship between hemorheological and hemostatic factors changes are discussed.

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Antithrombin III (AT III) and Fibrinogen Levels in Nephrotic Syndrome in Children

Cited by 9 publications

References 10 publications

Haemostatic measurements in childhood nephrotic syndrome

Haemostatic measurements in childhood nephrotic syndrome

Coagulopathy of Childhood Nephrotic Syndrome – A Reappraisal of the Role of Natural Anticoagulants and Fibrinolysis

Hemorheological and Hemostatic Parameters in Children with Nephrotic Syndrome Undergoing Steroid Therapy

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