Thrombotic Events in Patients with Nephrotic Syndrome

Nephrotic syndrome (NS) is associated with hypercoagulable state and a risk of thromboembolism. The incidence, risk factors and response to treatment in children varies between different publications. The aim of this study was to describe the incidence, risk factors and treatment of thromboembolic complications in children diagnosed with NS.

Methods: retrospective analysis from charts of children with NS, followed in Schneider Children’s Medical Center between 1999 -2019. All children were evaluated for hemoglobin, albumin, cholesterol, triglycerides levels and urine protein/creatinine ratio .Children with thromboembolic events were evaluated for risk factors including: Antithrombin 3, Protein C +S, Homocysteine, Lipoprotein A, APLA/LAC, Factor 5 Leiden, Factor 8,.

We reviewed demographic parameters, time from diagnosis of NS to thrombosis, anticoagulation treatment and the dose required for achieving therapeutic drug levels.

Results: Among 213 children with NS 10 (4.7%) had thromboembolic event. Mean age at diagnosis of NS was 3.9 years (1.5-16 years). Mean time from diagnosis to thromboembolic event was 1.6 years (6 weeks-18.3 years). All children were during disease exacerbation and had a venous thromboembolism (VT), 3(30%) had catheter-related thrombosis.

Among patients with VT, 40% were steroid dependent, 50% were steroid resistant. 9/10 patients were under steroid sparing treatment at time of VT event. Children with VT events were older (mean age 6.6 years) had decreased AT3 levels (78%), higher triglycerides and protein/creatinine ratio compared to children without VT events.

Discussion: Thromboembolism can be a devastating event among children with NS, Prophylactic therapy may be considered in specific NS patients.