1527 COAGULATION AND THE NEPHROTIC SYNDROME

Abstract

The coagulation and fibrinolytic systems were studied in children with nephrotic syndrome using methods including plasma fibrinogen chromatography (Kid.Int.1976,10,319). Patients with minimal change disease (MCNS) were studied sequentially i) relapse on no treatment (n=34), ii) relapse receiving steroids (n=12), iii) early remission on steroids (n=14), iv) late remission on steroids (n=17) and v) late remission, no treatment (n=10). Other nephrotics, including those with focal glomerulosclerosis (FGS) were studied too and compared to normal subjects. Irrespective of underlying cause, untreated nephrotic subjects had significantly elevated plasma levels of fibrinogen, high molecular weight fibrin-fibrinogen complexes and fibrinogen first derivatives. α2 macroglobulin levels were elevated too whereas, factor XIII, α1-antitrypsin, plasminogen and, surprisingly, antithrombin III levels were not different from normal. Values reverted toward normal when MCNS patients began to respond to steroid treatment (group iii) and were normal in groups iv and v. Abnormalities persisted in FGS patients who remained nephrotic. Thus coagulation changes occur prior to the administration of steroids and appear to be nonspecific being found in nephrotic syndrome irrespective of etiology. Our study provides a rationale for the recently advocated longterm use of oral anticoagulants in FGS patients (J.Ped.Neph.,1980,1,18) to prevent development of glomerulosclerosis and chronic renal failure.