Disease-specific risk of venous thromboembolic events is increased in idiopathic glomerulonephritis

Barbour, Sean J.; Greenwald, Allen; Djurdjev, Ognjenka; Levin, Adeera; Hladunewich, Michelle A.; Nachman, Patrick H.; Hogan, Susan L.; Cattran, Daniel C.; Reich, Heather N.

doi:10.1038/ki.2011.312

Cited by 174 publications

(161 citation statements)

References 19 publications

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“…The frequency of VTE observed in this study is consistent with what has previously been described in the nephrotic syndrome associated with membranous nephropathy 11,12 and with what has been reported in AL and multiple myeloma. 5,24,25 Interestingly, no renal vein thromboses were documented in this group; this may reflect the often clinically silent nature of these events, which have been observed in as many as 40-50% of patients with nephrotic syndrome, 15 but were not screened for in our population.…”

Section: Discussionsupporting

confidence: 81%

“…[26][27][28][29] The association between low serum albumin and risk of VTE has been previously described in nephrotic syndrome. 11,12,14,30 Serum albumin is inversely correlated with the degree of urinary protein loss, and may be a surrogate marker for loss of endogenous antithrombotic proteins such as antithrombin III and plasminogen. Serum albumin levels may have direct effects on hemostasis and platelet aggregation 26 and in addition levels may be decreased in critical illness and thus correlate with more advanced disease.…”

Section: Discussionmentioning

confidence: 99%

“…The nephrotic syndrome, a common presentation of AL, is associated with hypercoagulability and may contribute to the risk of venous thromboembolism (VTE) in this population. [10][11][12][13][14][15] Other potential contributors to thromboembolic risk include monoclonal gammopathy and plasma cell dyscrasia 16 as well as AL treatments, specifically immunomodulatory agents (IMiDs) [17][18][19][20][21][22][23] and those requiring central venous catheters. A means of risk stratification of VTE in this population is needed to guide prophylaxis and treatment strategies.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for venous thromboembolism in immunoglobulin light chain amyloidosis

et al. 2015

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P atients with immunoglobulin light chain amyloidosis are at risk for both thrombotic and bleeding complications. While the hemostatic defects have been extensively studied, less is known about thrombotic complications in this disease. This retrospective study examined the frequency of venous thromboembolism in 929 patients with immunoglobulin light chain amyloidosis presenting to a single referral center, correlated risk of venous thromboembolism with clinical and laboratory factors, and examined complications of anticoagulation in this population. Sixty-five patients (7%) were documented as having at least one venous thromboembolic event. Eighty percent of these patients had events within one year prior to or following diagnosis. Lower serum albumin was associated with increased risk of VTE, with a hazard ratio of 4.30 (CI 1.60-11.55; P=0.0038) for serum albumin less than 3 g/dL compared to serum albumin greater than 4 g/dL. Severe bleeding complications were observed in 5 out of 57 patients with venous thromboembolism undergoing treatment with anticoagulation. Prospective investigation should be undertaken to better risk stratify these patients and to determine the optimal strategies for prophylaxis against and management of venous thromboembolism. Risk factors for venous thromboembolism in immunoglobulin light chain amyloidosis

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk factors for venous thromboembolism in immunoglobulin light chain amyloidosis

et al. 2015

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“…Conservative therapy alone has its own downsides, including an increased thromboembolic risk, premature atherosclerosis, and the potential for irreversible kidney injury (2,3). Recent data confirmed the significant spontaneous remission rate, regardless of initial proteinuria and, in some cases, regardless of the initial renal function (4,5).…”

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confidence: 55%

Is Long-Term Prediction in Membranous Nephropathy (MGN) Better Than the Weatherman's Forecast Capacity?

Cattran

Kim

2012

Clinical Journal of the American Society of Nephrology

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The natural history of membranous nephropathy (MGN) was first described in the late 1960s by Pollock et al. (1). This paper clearly identified that only 40%-50% of patients will progress over time and up to 30% will have a spontaneous remission. This natural history has both vexed and fascinated clinical nephrologists since that time.All nephrologists can appreciate the value of early separation of progressors from nonprogressors given our current potent immunosuppressive drugs with their significant adverse effects. Conservative therapy alone has its own downsides, including an increased thromboembolic risk, premature atherosclerosis, and the potential for irreversible kidney injury (2,3). Recent data confirmed the significant spontaneous remission rate, regardless of initial proteinuria and, in some cases, regardless of the initial renal function (4,5).Almost two decades ago, the Toronto group looked at whether the persistence of proteinuria above certain cutoff values would improve the overall accuracy of predicting chronic renal insufficiency. When we added initial renal function and rate of renal function decline over a time frame of observation to these proteinuria cutoffs, we improved baseline prediction from 25% to an accuracy of 80% (6). However, there are challenges with this prediction tool, including an observation period of up to 18 months and a somewhat complex calculation to determine the risk score.Many advances in nephrology practice have been made since that time. Significant improvements in conservative management of the proteinuric patient include widespread use of renin-angiotensin systemblocking agents and lower target BP. In addition, there are now new options in immunosuppressive drugs. This is on a background of changing demographics with the average presenting MGN patient now older by two decades and many with additional comorbidities such as hypertension and obesity compared with the original cohort (7). All these changes bring into sharp focus the question of whether the old methods of prediction still apply. This is a question addressed in an article by van den Brand et al. (8) on other urinary markers in this issue of CJASN. This different approach to prediction has been championed for over a decade by this group examining MGN outcome relative to the initial levels of low and high molecular urine protein biomarkers (9-12). The current article is the first to compare predictive accuracy of these two approaches in MGN.The authors conclude that the area under the receiver operating characteristic curves (ROC-AUC) between the Toronto risk score and either of their urinary protein biomarkers, b2 microglobulin or urinary a1 microglobulin are very similar despite exposure to the newer conservative treatment agents including angiotensin-converting enzyme and/or angiotensin II receptor blocker therapies (ROC-AUC 0.78 versus 0.795; 95% CI, 0.69-0.88). This conclusion must be tempered in light of the limited details about renin angiotensin system blockade exposure because neither dose nor dur...

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“…Deep vein thrombosis, especially renal vein thrombosis, is reported to occur more frequently among patients with membranous nephropathy (MN) than other nephrotic diseases (2)(3)(4)(5)(6)(7)(8)(9). Given the impact of thrombotic events on morbidity and mortality of patients with nephrotic syndrome, the question of prophylactic anticoagulation presents an important clinical dilemma for which no evidence-based guidelines are available.…”

Section: Introductionmentioning

confidence: 99%

Venous Thromboembolism in Patients with Membranous Nephropathy

Lionaki¹,

Derebail²,

Hogan³

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives The aims of this study were to determine the frequency of venous thromboembolic events in a large cohort of patients with idiopathic membranous nephropathy and to identify predisposing risk factors.Design, setting, participants, & measurements We studied patients with biopsy-proven membranous nephropathy from the Glomerular Disease Collaborative Network (n=412) and the Toronto Glomerulonephritis Registry (n=486) inception cohorts. The cohorts were pooled after establishing similar baseline characteristics (total n=898). Clinically apparent and radiologically confirmed venous thromboembolic events were identified. Potential risk factors were evaluated using multivariable logistic regression models.Results Sixty-five (7.2%) subjects had at least one venous thromboembolic event, and this rate did not differ significantly between registries. Most venous thromboembolic events occurred within 2 years of first clinical assessment (median time to VTE = 3.8 months). After adjusting for age, sex, proteinuria, and immunosuppressive therapy, hypoalbuminemia at diagnosis was the only independent predictor of a venous thromboembolic event. Each 1.0 g/dl reduction in serum albumin was associated with a 2.13-fold increased risk of VTE. An albumin level ,2.8 g/dl was the threshold below which risk for a venous thromboembolic event was greatest.Conclusions We conclude that clinically apparent venous thromboembolic events occur in about 7% of patients with membranous nephropathy. Hypoalbuminemia, particularly ,2.8 g/dl, is the most significant independent predictor of venous thrombotic risk.

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Disease-specific risk of venous thromboembolic events is increased in idiopathic glomerulonephritis

Cited by 174 publications

References 19 publications

Risk factors for venous thromboembolism in immunoglobulin light chain amyloidosis

Risk factors for venous thromboembolism in immunoglobulin light chain amyloidosis

Is Long-Term Prediction in Membranous Nephropathy (MGN) Better Than the Weatherman's Forecast Capacity?

Venous Thromboembolism in Patients with Membranous Nephropathy

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