Impact of acute kidney injury on coagulation in adult minimal change nephropathy

Huang, Mengjie; Wei, Ri-bao; Su, Ting-Yu; Wang, Yang; Li, Qingping; Xi, Yang; Lv, Xiaomeng; Chen, Xiangmei

doi:10.1097/md.0000000000005366

Cited by 14 publications

(17 citation statements)

References 27 publications

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“…(4)(5)(6) Recently, similar hemostatic alterations have been described in patients with AKI without chronic liver disease. (7)(8)(9)(10) AKI is a relatively common complication of decompensated cirrhosis, occurring in approximately 20% of hospitalized patients, (11) and may be associated with an increased risk of bleeding. (3,12,13) However, the effect of AKI on the hemostatic system in patients with cirrhosis has not yet been fully investigated.…”

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confidence: 99%

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Acute Kidney Injury in Decompensated Cirrhosis Is Associated With Both Hypo‐coagulable and Hyper‐coagulable Features

et al. 2020

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BaCKgRoUND aND aIMS: Recent evidence suggests that acute kidney injury (AKI) is the main predictor of postparacentesis bleeding in patients with cirrhosis. To assess the factors responsible for bleeding tendency in AKI, we performed a prospective study comparing all three aspects of hemostasis (platelets, coagulation, and fibrinolysis) in patients with decompensated cirrhosis with and without AKI. appRoaCH aND ReSUltS: Primary hemostasis assessment included platelet aggregation and secretion (platelet function markers) and von Willebrand factor. Secondary hemostasis assessment included pro-coagulant (factor VIII and factor XIII) and anti-coagulant (protein C, protein S, and antithrombin) factors and thrombin generation. Tertiary hemostasis assessment included fibrinolytic factors and plasmin-antiplasmin complex. Eighty patients with decompensated cirrhosis were recruited (40 each with and without AKI). Severity of cirrhosis and platelet count were comparable between groups. Median serum creatinine was 1.8 mg/dL and 0.8 mg/dL in patients with and without AKI, respectively. At baseline, patients with cirrhosis and AKI had lower platelet aggregation and secretion, indicative of impaired platelet function (increased bleeding tendency), without differences in von Willebrand factor. Regarding coagulation factors, factor VIII was higher, whereas protein C, protein S, and antithrombin were all lower, which, together with increased thrombin generation, indicate hypercoagulability. In contrast, factor XIII was lower in AKI (increased bleeding tendency). Finally, while both hypofibrinolytic and hyperfibrinolytic changes were present in AKI, a higher plasmin-antiplasmin complex indicated a hyperfibrinolytic state. After AKI resolution (n = 23 of 40), platelet function and coagulation improved to levels observed in patients with cirrhosis patients without AKI; however, fibrinolysis remained hyperactivated. CoNClUSIoNS: In patients with decompensated cirrhosis, AKI is associated with both hypocoagulable and hypercoagulable features that can potentially increase the risk of both bleeding and thrombosis. (Hepatology 2020;72:1327-1340). P atients with decompensated cirrhosis have multiple and complex alterations of hemostasis that predispose them to both bleeding and thrombotic complications. (1) Although patients with cirrhosis are traditionally considered to be at high risk of bleeding from procedures, data regarding the correlation between hemostatic

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confidence: 99%

“…( 4‐6 ) Recently, similar hemostatic alterations have been described in patients with AKI without chronic liver disease. ( 7‐10 )…”

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confidence: 99%

Acute Kidney Injury in Decompensated Cirrhosis Is Associated With Both Hypo‐coagulable and Hyper‐coagulable Features

et al. 2020

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“…Increased levels of FIB result in an increase in blood viscosity, leading to shear stress damage in endothelial cells (18). Studies have shown that FIB in tissues is significantly elevated in acute kidney injury caused by ischemia-reperfusion (19)(20)(21). FIB causes severe renal dysfunction by increasing renal fibrosis (22).…”

Section: Discussionmentioning

confidence: 99%

Predictive value of combining the level of fibrinogen and antithrombin III for contrast‑induced nephropathy in coronary artery disease patients undergoing percutaneous coronary intervention

et al. 2020

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Contrast-induced nephropathy (CIN) is a common adverse event in the diagnosis and treatment of coronary intervention. The current study investigated the predictive effect of preoperative fibrinogen (FIB) combined with antithrombin III (AT-III) on CIN following percutaneous coronary intervention (PCI). A total of 394 patients who underwent PCI between October 2018 and May 2019 were selected for the present study. Pre-procedural FIB levels and AT-III activity were measured before PCI. CIN was defined as a 0.5 mg/dl or 25% increase in serum creatinine levels 48 to 72 h after exposure to a radiocontrast agent. Patients were classified into CIN and non-CIN groups. CIN occurred in 48 (12.2%) patients. The serum FIB levels were significantly higher in patients who developed CIN compared with those who did not develop CIN. In addition, AT-III levels ≤89.5% were associated with higher rates of CIN. Logistical regression analysis showed that high FIB, and low AT-III and albumin levels were high-risk factors associated with CIN. For FIB, the area under the receiver operating characteristic curve (AUC) for predicting CIN was 0.653. The optimal cutoff value was 3.48 g/l with a sensitivity of 45.8% and a specificity of 79.7% [95% confidence interval (CI): 0.603-0.701; P= 0.0002)]. For AT-III, the AUC was 0.711, and the optimal cutoff value was 89.5%, with a sensitivity of 81.3% and specificity of 58.2% (95% CI: 0.659-0.758; P<0.0001). When combining FIB and AT-III, the AUC was 0.747. The optimal cutoff value was 0.090424, with a diagnostic sensitivity of 93.8% and specificity of 46.6% (95% CI: 0.697-0.792; P<0.0001). The results showed that FIB combined with AT-III resulted in improved predictive accuracy of CIN (FIB vs. AT-III, AUC= 0.653 vs. 0.711, P= 0.292; FIB vs. FIB + AT-III, AUC= 0.653 vs. 0.747, P= 0.012; AT-III vs. FIB + AT-III, AUC=0.711 vs. 0.747, P=0.138). Pre-procedural levels of FIB, AT-III and albumin were independently associated with an increased risk of CIN. Furthermore, the results suggested that the combination of FIB and AT-III was a better predictor of CIN after PCI.

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“… 3 Indeed, several studies have described adult minimal change nephropathy complicated by pulmonary embolism. 22 – 24 Furthermore, adult patients with minimal change disease complicated by acute kidney injury, which are seen more frequently in older adults than in younger patients, 25 may have a severe hypercoagulable state. 24 The favorable decline in the serum Cr level along with a reduction in the urine protein level in the current patient implies the concurrent reversible acute kidney injury despite the lack of objective time course data indicating the functional status before the onset of NS.…”

Section: Discussionmentioning

confidence: 99%

“… 22 – 24 Furthermore, adult patients with minimal change disease complicated by acute kidney injury, which are seen more frequently in older adults than in younger patients, 25 may have a severe hypercoagulable state. 24 The favorable decline in the serum Cr level along with a reduction in the urine protein level in the current patient implies the concurrent reversible acute kidney injury despite the lack of objective time course data indicating the functional status before the onset of NS. Finally, the low rate of reported adverse events with anticoagulation as well as our patient’s markedly decreased serum Alb levels encouraged us to pursue heparinization prior to the renal biopsy as practiced empirically.…”

Section: Discussionmentioning

confidence: 99%

Retroperitoneal Bleeding: An Experience During Prophylactic Anticoagulation in a Patient With Nephrotic Syndrome

Okada

Akimoto

Kawamata

et al. 2017

Clin Med Insights Case Rep

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The association between nephrotic syndrome (NS) and a hypercoagulable state has been demonstrated. Controlling the blood clotting activity may therefore be attractive for patients with nephrosis in terms of thromboembolism prophylaxis. We herein report a 75-year-old woman with minimal change disease who developed pains in the right back, groin, and thigh because of retroperitoneal bleeding during prophylactic anticoagulation with unfractionated heparin. Although this procedure has not been accepted as the standard of care for patients with nephrosis, pharmacologic prophylaxis may already be practiced empirically, as in the present patient. We believe that our experience highlights the pitfalls of such a management in patients with nephrosis, implying the need for a diagnostic strategy for identifying those patients with NS who can benefit from prophylactic anticoagulation. Several concerns that emerged in this case are also discussed.

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Impact of acute kidney injury on coagulation in adult minimal change nephropathy

Cited by 14 publications

References 27 publications

Acute Kidney Injury in Decompensated Cirrhosis Is Associated With Both Hypo‐coagulable and Hyper‐coagulable Features

Acute Kidney Injury in Decompensated Cirrhosis Is Associated With Both Hypo‐coagulable and Hyper‐coagulable Features

Predictive value of combining the level of fibrinogen and antithrombin III for contrast‑induced nephropathy in coronary artery disease patients undergoing percutaneous coronary intervention

Retroperitoneal Bleeding: An Experience During Prophylactic Anticoagulation in a Patient With Nephrotic Syndrome

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