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 Printable version |
Thromboembolic risk in idiopathic nephrotic syndrome of childhood |
Sang Thrombose Vaisseaux. Volume 18, Number 9, 478-88, Novembre 2006, Mini-revue
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 Résumé
Article gratuit
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Author(s) : Mathilde Jehanne, Valérie Bardet, Erwan Pencreach, Georges Deschênes, Rémi Favier |
Summary : Nephrotic syndrome is a disease associated with many severe complications, the most severe of which, and potentially fatal, being thromboembolism and infections. Although thrombosis risk is apparently lower in children than in adults, its true incidence is probably surestimated due to the different clinical and imaging methods used for the diagnosis. Many factors play a role in the dysregulated coagulation state of the nephrotic syndrome. Prothrombotic parameters which as elevated fibrogen levels, change in antithrombin levels, platelet abnormalities, have been implicated as the initiating factors that increase thrombosis risk but other biological factors such as activation of endothelial cells, levels of some parameters of the fibrinolytic system, blood hyperviscosity, hypoalbuminemia and hyperlipedemia also play a role. Other non-biological factors including diuretic use, presence of an in-dwelling catheter, corticosteroid treatment and immobilisation also contribute to increase risk. Nevertheless, no laboratory test can reliably predict the real thrombotic risk and the value of a systematic search for inherited coagulation abnormalities remains to be determined. In each patient, the risk is the result of several different parameters which may vary not only from one patient to another but also in the same patient from one period to another. To date, there are no data upon which to base recommendations for prophylactic anticoagulation. The French Society of Pediatric Nephrology has underlined some situations at risk and has suggested some recommendations but, currently, there is an urgent need for prospective randomized clinical trials for infants and children with disease associated with acquired risk of thrombosis. |
Keywords : nephrotic syndrome, childhood, acquired hypercoagulable state, thromboembolism |
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