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Semin Thromb Hemost 2013; 39(05): 469-476
DOI: 10.1055/s-0033-1343887
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Thrombosis in Nephrotic Syndrome

Biagio Barbano
1   Department of Clinical Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy
,
Antonietta Gigante
1   Department of Clinical Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy
,
Antonio Amoroso
1   Department of Clinical Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy
,
Rosario Cianci
1   Department of Clinical Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy
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Publikationsdatum:
27. April 2013 (online)

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Abstract

Nephrotic syndrome (NS) is characterized by heavy proteinuria, edema, hypoalbuminemia, and hyperlipidemia and the most frequent causes are glomerular diseases. An uncommon presentation is iatrogenic NS, an adverse effect of some drugs administration. In the clinical course of NS, a typical feature is dysregulated coagulation state, promoted by the breakdown of permselectivity barrier of the glomerular capillary wall, resulting in the leakage of high-molecular-mass proteins, at least the size of albumin. This hypercoagulable condition is supported by several factors, such as abnormalities in platelet activation and an imbalance between anticoagulation/antithrombosis and procoagulant/prothrombotic mechanisms. Thus, NS and the risk of developing thromboses are strictly related. Thrombotic events affect the venous system rather than arterial vessels with different features and frequencies. Deep venous system of the lower extremities and renal veins are the most frequent source of pulmonary embolism, the most dangerous NS complication. Prophylactic anticoagulation and thrombosis treatment are not clearly established because large randomized trials and guidelines are lacking. The management of NS and the decision of when and how to anticoagulate the patient represent a teamwork challenge for physicians.

Keywords

arterial thrombosis - deep vein thrombosis - nephrotic syndrome - proteinuria - renal vein thrombosis - pulmonary embolism
 

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