Nephrotic Syndrome

[GenReeOla, LVN]

Does anyone know how and why there is delayed clotting, increased PTT/PT/INR, but high risk for Thromboembolisms? Im confused and after an hour of google searching Im stumped!

[NRSKarenRN, BSN, RN]

I've found that searching emedicine.medscape.com usually has pathophysiology I'm desiring along with varying treatment options available. Karen

Nephrotic Syndrome: Pathophysiology

Quote

Hypercoagulability

Venous thrombosis and pulmonary embolism are well-known complications of the nephrotic syndrome. Hypercoagulability in these cases appears to derive from urinary loss of anticoagulant proteins, such as antithrombin III and plasminogen, along with the simultaneous increase in clotting factors, especially factors I, VII, VIII, and X.

A study by Mahmoodi et al of almost 300 patients with nephrotic syndrome confirmed that the annual incidence of venous thromboembolism (VTE) was almost 10 times higher in these persons than in the normal population (1% vs 0.1 to 0.2%). [14] Moreover, that risk appeared especially elevated during the first 6 months of nephrotic syndrome, being at almost 10%. This high incidence may justify the routine use of preventive anticoagulation treatment during the first 6 months of a persistent nephrotic syndrome.

Mahmoodi et al's study also showed an increased risk of arterial thrombotic events in subjects with nephrotic syndrome, including coronary and cerebrovascular ones. Unlike the risk of VTE, which was related to proteinuria, this arterial risk was related to usual risk factors for arterial disease, such as hypertension, diabetes, smoking, and reduced GFR

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