Evaluation of hemostasis disorders using the thrombodynamic test in patients with chronic glomerulonephritis with nephrotic syndrome

Cover Page

Cite item

Full Text

Abstract

Background. Nephrotic syndrome (NS) is accompanied by a risk of thrombotic complications due to hypercoagulability. Routine laboratory tests are not sensitive enough to detect these disorders, and therefore the use of integral coagulation tests, including a new thrombodynamic test (TT) in patients with NS, is of high relevance.

Aim. Using a TT to determine hemostasis disorders in patients with chronic glomerulonephritis (CGN) with NS.

Materials and methods. The study included 49 patients with CGN, mean age 37 years, of which 25 (51%) women and 24 (49%) men. Of all the examined patients, 20 (40.8%) of people had NS, 29 (59.2%) had no NS. The process of clot formation was assessed by TT.

Results. According to TT, 30% (6/20) of patients with NS and 13.7% (4/29) of patients without NS have hypercoagulation with changes in parameters that go beyond the reference values. In patients with NS, an increase in clot density (D), clot formation rate (V) and clot size (CS) was found, especially when albumin decreased below 25 g/l. Negative correlations were found between the levels of albumin, creatinine and clot density (D), which reflects the level of hyperfibrinogenemia, the rate of clot formation (V) and the integral index of coagulation (CS). The results indicate mainly the activation of the plasma hemostasis due to the internal coagulation pathway. However, the correlation of Tlag (delay time for the onset of clot formation after contact of blood plasma with the insert-activator) with serum cholesterol levels may also indicate activation of the extrinsic coagulation pathway.

Conclusion. In CGN patients with NS, activation of the plasma hemostasis is noted, as evidenced by an increase in the rate of formation (V) and size of the clot (CS) after 30 minutes, as well as the density of the formed clot (D).

About the authors

Angelina S. Berns

Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: svberns@yandex.ru
ORCID iD: 0000-0002-6838-0754

аспирант каф. внутренних, профессиональных болезней и ревматологии Института клинической медицины им. Н.В. Склифосовского

Russian Federation, Moscow

Egor N. Sovetnikov

Lomonosov Moscow State University

Email: svberns@yandex.ru
ORCID iD: 0000-0001-8057-7616

студент

Russian Federation, Moscow

Natalia V. Chebotareva

Sechenov First Moscow State Medical University (Sechenov University)

Email: svberns@yandex.ru
ORCID iD: 0000-0003-2128-8560

д-р мед. наук, проф. каф. внутренних, профессиональных болезней и ревматологии Института клинической медицины им. Н.В. Склифосовского

Russian Federation, Moscow

Svetlana A. Berns

National Medical Research Center for Therapy and Preventive Medicine

Email: svberns@yandex.ru
ORCID iD: 0000-0003-1002-1895

д-р мед. наук, проф. каф. терапии и общей практики Института профессионального образования и аккредитации

Russian Federation, Moscow

Alena D. Solonkina

Sechenov First Moscow State Medical University (Sechenov University)

Email: svberns@yandex.ru
ORCID iD: 0000-0003-0305-8251

студент

Russian Federation, Moscow

Sergei V. Guliaev

Sechenov First Moscow State Medical University (Sechenov University)

Email: svberns@yandex.ru
ORCID iD: 0000-0001-6138-4333

канд. мед. наук, доц. каф. внутренних, профессиональных болезней и ревматологии Института клинической медицины им. Н.В. Склифосовского

Russian Federation, Moscow

Valentina V. Kraeva

Sechenov First Moscow State Medical University (Sechenov University)

Email: svberns@yandex.ru
ORCID iD: 0000-0003-2141-6411

канд. мед. наук, доц. каф. внутренних, профессиональных болезней и ревматологии Института клинической медицины им. Н.В. Склифосовского

Russian Federation, Moscow

Sergey V. Moiseev

Sechenov First Moscow State Medical University (Sechenov University)

Email: svberns@yandex.ru
ORCID iD: 0000-0002-7232-4640

акад. РАН, д-р мед. наук, проф., проф. каф. внутренних, профессиональных болезней и ревматологии Института клинической медицины им. Н.В. Склифосовского, дир. Клиники ревматологии, нефрологии и профпатологии им. Е.М. Тареева Университетской клинической больницы №3

Russian Federation, Moscow

References

  1. Bellomo R, Atkins RC. Membranous nephropathy and thromboembolism: Is prophylactic anticoagulation warranted? Nephron. 1993;63(3):249-54. doi: 10.1159/000187205
  2. Orth SR, Ritz E. The nephrotic syndrome. N Engl J Med. 1998;338(17):1202-11. doi: 10.1056/NEJM199804233381707
  3. Schlegel N. Thromboembolic risks and complications in nephrotic children. Semin Thromb Hemost. 1997;23(3):271-80. doi: 10.1055/s-2007-996100
  4. Llach F, Koffler A, Finck E, Massry SG. On the incidence of renal vein thrombosis in the nephrotic syndrome. Arch Intern Med. 1977;137:333-6.
  5. Singhal R, Brimble KS. Thromboembolic complications in the nephrotic syndrome: Pathophysiology and clinical management. Thromb Res. 2006;118(3):397-407. doi: 10.1016/j.thromres.2005.03.030
  6. Mahmoodi BK, ten Kate MK, Waanders F, et al. High Absolute Risks and Predictors of Venous and Arterial Thromboembolic Events in Patients With Nephrotic Syndrome: Results From a Large Retrospective Cohort Study. Circulation. 2008;117(2):224-30. doi: 10.1161/Circulationaha.107.716951
  7. Zhang LJ, Zang Z, Li SJ, et al. Pulmonary Embolism and Renal Vein Thrombosis in Patients With Nephrotic Syndrome: Prospective Evaluation of Prevalence and Risk Factors With CT. Radiology. 2014;273(3):897-906. doi: 10.1148/radiol.14140121
  8. Fahal IH, McClelland P, Hay CR, Bell JM. Arterial thrombosis in the nephrotic syndrome. Postgrad Med J. 1994;70(830):905-9. doi: 10.1136/pgmj.70.830.905
  9. Singhal R, Brimble KS. Thromboembolic complications in the nephrotic syndrome: pathophysiology and clinical management. Thromb Res. 2006;118(3):397-407. doi: 10.1016/j.thromres.2005.03.030
  10. Curry ANG, Pierce JMT. Conventional and near-patient tests of coagulation. Continuing Education in Anaesthesia. Anaesth Crit Care Pain Med. 2007;7(2):45-50. doi: 10.1093/BJACEACCP/MKM002
  11. Yalсinkaya F, Tomer N, Gorgani AN, et al. Haemostatic parameters in childhood nephrotic syndrome. Int Urol Nephrol.1995;27(5):643-7. doi: 10.1007/BF02564753
  12. Panteleev MA, Hemker HC. Global/integral assays in hemostasis diagnostics: Promises, successes, problems and prospects. Thromb J. 2015;13(1):1-4. doi: 10.1186/s12959-014-0032-y
  13. Sinauridze EI, Vuimo TA, Tarandovskiy ID, et al. Thrombodynamics, a new global coagulation test: Measurement of heparin efficiency. Talanta. 2018;180:282-91. doi: 10.1016/j.talanta.2017.12.055
  14. Fadeeva OA, Panteleev MA, Karamzin SS, et al. Thromboplastin immobilized on polystyrene surface exhibits kinetic characteristics close to those for the native protein and activates in vitro blood coagulation similarly to thromboplastin on fibroblasts. Biochemistry (Mosc). 2010;75:734-43. doi: 10.1134/s0006297910060088
  15. Koltsova EM, Balandina AN, Grischuk KI, et al. The laboratory control of anticoagulant thromboprophylaxis during the early postpartum period after cesarean delivery. J Perinat Med. 2018;46:251-60. doi: 10.1515/jpm-2016-0333
  16. Balandina AN, Serebriyskiy II, Poletaev AV, et al. Thrombodynamics – a new global hemostasis assay for heparin monitoring in patients under the anticoagulant treatment. PLoS One. 2018;13(6):e0199900. doi: 10.1371/journal.pone.0199900
  17. Паршина С.С. Глобальный тест тромбодинамики в диагностике и лечении больных сердечно-сосудистой патологией. Бюллетень медицинских интернет-конференций. 2016;6(8):1437-8 [Parshina SS. Global thrombodynamics test in the diagnosis and treatment of patients with cardiovascular pathology. Bulletin of Medical Internet Conferences. 2016;6(8):1437-8 (in Russian)].
  18. Gyamlani G, Miklos Z, Molnar MZ, et al. Association of serum albumin level and venous thromboembolic events in a large cohort of patients with nephrotic syndrome. Nephrol Dial Transplant. 2017;32(1):157-64. doi: 10.1093/ndt/gfw227
  19. Kumar G, Sakhuja A, Taneja A, et al. Pulmonary embolism in patients with CKD and ESRD. Clin J Am Soc Nephrol. 2012;7(10):1584-90.
  20. Singh J, Khadka S, Solanki D, et al. Pulmonary embolism in chronic kidney disease and end-stage renal disease hospitalizations: Trends, outcomes, and predictors of mortality in the United States. SAGE Open Med. 2021;3(9). doi: 10.1177/20503121211022996
  21. Owens AP 3rd, Passam FH, Antoniak S, et al. Monocyte tissue factor-dependent activation of coagulation in hypercholesterolemic mice and monkeys is inhibited by simvastatin. J Clin Invest. 2012;122(2):558-68. doi: 10.1172/JCI58969
  22. Huang MJ, Wei RB, Wang ZC, et al. Mechanisms of hypercoagulability in nephrotic syndrome associated with membranous nephropathy as assessed by thromboelastography. Thromb Res. 2015;136(3):663-8.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Tlag, V, D, CS-parameters in patients with chronic glomerulonephritis compared with healthy controls.

Download (158KB)
Indexing metadata

Copyright (c) 2022 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 
 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies