Thrombosis in Chronic Kidney Disease in Children

Abstract

Venous thromboembolism (VTE) in children is a rare condition. An increased incidence has been observed in the last few years due to several factors, such as increased survival in chronic conditions, especially chronic kidney disease (CKD), use of catheters, and increased sensitivity of diagnostic tools. VTE includes deep vein thrombosis (DVT) and pulmonary embolism (PE). VTE in children is associated with a two to six times higher mortality risk and a 5–10% prevalence of post-thrombotic syndrome. Overall, 5% of VTE episodes in children are associated with chronic kidney disease. The etiology of VTE in chronic kidney disease covers a wide range of pathologies. Various types of thrombotic complications may occur during long-term use of a chronic dialysis catheter. VTE occurs in 3% of children with nephrotic syndrome (NS). The risks for VTE and arterial thromboembolism (ATE) were particularly high in the first 6 months after the onset of NS. Other causes of VTE are graft rejection due to thrombosis of vascular anastomoses after kidney transplantation (3%) and autoimmune diseases (lupus nephritis, antiphospholipid syndrome). In this state-of-the-art overview, we have reviewed the physiologic and pathologic mechanisms underlying pediatric thrombosis and updated current diagnostic and treatment options, emphasizing personal experience as well.

Deep venous thrombosis following placement of temporary hemodialysis catheters in patients with chronic kidney disease

“…17 CKD favors Virchow's triad by leading to venous stasis (e.g., immobility due to anasarca), endothelial damage (HDC), and hypercoagulability (diuretics). 18 Levels of factor VII, VIII, von Willebrand factor, and D-dimer are elevated in patients with ESRD. Factors VII and VIII have been correlated with risk of VTE.…”

Pitfalls of Thrombotic Microangiopathies in Children: Two Case Reports and Literature Review

“…The novel SARS-CoV-2 virus infection has had an impact on our understanding of the previously unknown interactions between the immunological mechanism and the coagulation cascade. In a pediatric patient, the risk of developing venous thromboembolism is strongly associated with the existence and advancement of underlying pathological conditions [ 38 ]. Over the course of the pandemic, novel conditions and complications have surfaced, such as multisystem inflammatory syndrome in children (MIS-C), which frequently resembles other established diseases, such as thrombotic microangiopathy or Kawasaki disease [ 39 , 40 ].…”

Leveling the playing field: The role of level‐based dosing in pediatric anticoagulation management

“…Developmental differences in hemostatic system with age [4][5][6][7] and the diversity of indications for antithrombosis therapy make the pediatric population uniquely and inherently heterogeneous. [8][9][10][11][12][13][14] Additionally, the children that tend to utilize antithrombosis therapies most frequently include those with oncologic or cardiac disease, both groups with seemingly constant high risk of both bleeding and clotting. Therefore, the necessity for consistent and "appropriate" dosing of a high-alert medication for a high-risk population presents a compelling rationale for utilizing laboratory monitoring.…”

“…Developmental differences in hemostatic system with age 4–7 and the diversity of indications for antithrombosis therapy make the pediatric population uniquely and inherently heterogeneous 8–14 . Additionally, the children that tend to utilize antithrombosis therapies most frequently include those with oncologic or cardiac disease, both groups with seemingly constant high risk of both bleeding and clotting.…”