Primary Nephrotic Syndrome in Adults as a Risk Factor for Pulmonary Embolism: An Up-to-Date Review of the Literature

Abstract

Patients with nephrotic syndrome are at an increased risk for thrombotic events; deep venous thrombosis, renal vein thrombosis, and pulmonary embolism are quite common in patients with nephrotic syndrome. It is important to note that nephrotic syndrome secondary to membranous nephropathy may impose a greater thrombotic risk for unclear reasons. Increased platelet activation, enhanced red blood cell aggregation, and an imbalance between procoagulant and anticoagulant factors are thought to underlie the excessive thrombotic risk in patients with nephrotic syndrome. The current scientific literature suggests that patients with low serum albumin levels and membranous nephropathy may benefit from primary prophylactic anticoagulation. A thorough approach which includes accounting for all additional thrombotic risk factors is, therefore, essential. Patient counseling regarding the pros and cons of anticoagulation is of paramount importance. Future prospective randomized studies should address the question regarding the utility of primary thromboprophylaxis in patients with nephrotic syndrome.

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

“…Age and the albumin level were the confounding factors that affect coagulation and thromboembolism. [7–9] Thus, we introduced the propensity score matching (PSM) method which has been widely used in the observational studies to adjust for differences in the baseline patient characteristics between the study and control groups and to reduce the biases and potential confounding factors. [10] …”

Mechanisms of hypercoagulability in nephrotic syndrome associated with membranous nephropathy as assessed by thromboelastography

“…It is presently thought that the mechanisms are possibly associated with the involvement of multiple factors in the blood coagulation pathway [1][2][3]. Membranous nephropathy (MN) is the pathological type of NS associated with the highest incidence of thromboembolic events [2][3][4].…”

Nephrotic syndrome-induced thromboembolism in adults

“…The resulting hemoconcentration in the postglomerular circulation may promote thrombus formation in patients who are already hypercoagulable. [ 1 ]…”

“…[ 11 ] Other predictors of increased risk of thrombosis in NS include high fibrinogen levels and low antithrombin levels [ Table 3 ]. [ 1 ]…”

“…Although increased incidence of VTE is a well reported complication associated with nephrotic syndrome, the incidence, prevalence, risk factors and management strategies are not well established. [ 1 ]…”