Journal of Thrombosis and Thrombolysis

, Volume 30, Issue 3, pp 281–285

Relationship between proteinuria and venous thromboembolism

  • Shumei Kato
  • Svetlana Chernyavsky
  • Joji Erik Tokita
  • Yuichi J. Shimada
  • Peter Homel
  • Herman Rosen
  • James F. Winchester
Article

Abstract

Nephrotic syndrome is known to cause venous thromboembolism (VTE) due to urine loss of antithrombin III and activation of the coagulation system. We hypothesized that the degree of proteinuria may predict the development of VTE. This was a retrospective case-controlled study of in-patients urban academic teaching hospital from April, 2007 to March, 2009 and who had undergone an imaging study for VTE. All radiology reports (N = 1,647) for CT angiography of chest and Doppler sonogram of extremities were reviewed. The following data were collected: race/ethnicity, degree of proteinuria on urinalysis, serum protein and albumin levels, risk factors for VTE and renal function. The study population consisted of 284 patients with VTE and 280 age/sex matched controls. Relative to those who did not have proteinuria, patients who tested positive for protein had a 3.4-fold increased risk of VTE (odds ratio (OR) 3.4, 95% confidence interval [2.4, 5.0]). The association was unchanged when adjusted for other risk factors. Patients with proteinuria may have an increased risk of venous thromboembolism.

Keywords

Venous thromboembolism Proteinuria Urinalysis 

References

  1. 1.
    Heit JA, Melton LJ III, Lohse CM, Petterson TM, Silverstein MD, Mohr DN et al (2001) Incidence of venous thromboembolism in hospitalized patients vs community residents. Mayo Clin Proc 76:1102–1110CrossRefPubMedGoogle Scholar
  2. 2.
    Francis CW (2007) Clinical practice. Prophylaxis for thromboembolism in hospitalized medical patients. N Engl J Med 356:1438–1444CrossRefPubMedGoogle Scholar
  3. 3.
    Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR et al (2008) Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest 133(6 Suppl):381S–453SCrossRefPubMedGoogle Scholar
  4. 4.
    Cohen AT, Davidson BL, Gallus AS, Lassen MR, Prins MH, Tomkowski W et al (2006) Efficacy and safety of fondaparinux for the prevention of venous thromboembolism in older acute medical patients: randomised placebo controlled trial. BMJ 332:325–329CrossRefPubMedGoogle Scholar
  5. 5.
    Leizorovicz A, Cohen AT, Turpie AG, Olsson CG, Vaitkus PT, Goldhaber SZ (2004) Randomized, placebo-controlled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patients. Circulation 110:874–879CrossRefPubMedGoogle Scholar
  6. 6.
    Samama MM, Cohen AT, Darmon JY, Desjardins L, Eldor A, Janbon C et al (1999) A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. Prophylaxis in medical patients with Enoxaparin Study Group. N Engl J Med 341:793–800CrossRefPubMedGoogle Scholar
  7. 7.
    White RH (2003) The epidemiology of venous thromboembolism. Circulation 107(23 Suppl 1):I4–I8PubMedGoogle Scholar
  8. 8.
    Ambler B, Irvine S, Selvarajah V, Isles C (2008) Nephrotic syndrome presenting as deep vein thrombosis or pulmonary embolism. Emerg Med J 25:241–242CrossRefPubMedGoogle Scholar
  9. 9.
    Singhal R, Brimble KS (2006) Thromboembolic complications in the nephrotic syndrome: pathophysiology and clinical management. Thromb Res 118:397–407CrossRefPubMedGoogle Scholar
  10. 10.
    Mahmoodi BK, ten Kate MK, Waanders F, Veeger NJ, Brouwer JL, Vogt L et al (2008) High absolute risks and predictors of venous and arterial thromboembolic events in patients with nephrotic syndrome: results from a large retrospective cohort study. Circulation 117:224–230CrossRefPubMedGoogle Scholar
  11. 11.
    Kayali F, Najjar R, Aswad F, Matta F, Stein PD (2008) Venous thromboembolism in patients hospitalized with nephrotic syndrome. Am J Med 121:226–230CrossRefPubMedGoogle Scholar
  12. 12.
    Mahmoodi BK, Gansevoort RT, Veeger NJ, Matthews AG, Navis G, Hillege HL et al (2009) Microalbuminuria and risk of venous thromboembolism. JAMA 301:1790–1797CrossRefPubMedGoogle Scholar
  13. 13.
    Go AS, Fang MC, Udaltsova N, Chang Y, Pomernacki NK, Borowsky L et al (2009) Impact of proteinuria and glomerular filtration rate on risk of thromboembolism in atrial fibrillation: the anticoagulation and risk factors in atrial fibrillation (ATRIA) study. Circulation 119:1363–1369CrossRefPubMedGoogle Scholar
  14. 14.
    Gerstein HC, Mann JF, Yi Q, Zinman B, Dinneen SF, Hoogwerf B et al (2001) Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA 286:421–426CrossRefPubMedGoogle Scholar
  15. 15.
    Klausen K, Borch-Johnsen K, Feldt-Rasmussen B, Jensen G, Clausen P, Scharling H et al (2004) Very low levels of microalbuminuria are associated with increased risk of coronary heart disease and death independently of renal function, hypertension, and diabetes. Circulation 110:32–35CrossRefPubMedGoogle Scholar
  16. 16.
    Vigano-D’Angelo S, D’Angelo A, Kaufman CE Jr, Sholer C, Esmon CT, Comp PC (1987) Protein S deficiency occurs in the nephrotic syndrome. Ann Intern Med 107:42–47PubMedGoogle Scholar
  17. 17.
    Boneu B, Bouissou F, Abbal M, Sie P, Caranobe C, Barthe P (1981) Comparison of progressive antithrombin activity and the concentration of three thrombin inhibitors in nephrotic syndrome. Thromb Haemost 46:623–625PubMedGoogle Scholar
  18. 18.
    Kauffmann RH, Veltkamp JJ, Van Tilburg NH, Van Es LA (1978) Acquired antithrombin III deficiency and thrombosis in the nephrotic syndrome. Am J Med 65:607–613CrossRefPubMedGoogle Scholar
  19. 19.
    de Sain-van der Velden MG, Kaysen GA, de Meer K, Stellaard F, Voorbij HA, Reijngoud DJ et al (1998) Proportionate increase of fibrinogen and albumin synthesis in nephrotic patients: measurements with stable isotopes. Kidney Int 53:181–188CrossRefGoogle Scholar
  20. 20.
    Pedrinelli R, Giampietro O, Carmassi F, Melillo E, Dell’Omo G, Catapano G et al (1994) Microalbuminuria and endothelial dysfunction in essential hypertension. Lancet 344(8914):14–18CrossRefPubMedGoogle Scholar
  21. 21.
    Stehouwer CD, Nauta JJ, Zeldenrust GC, Hackeng WH, Donker AJ, den Ottolander GJ (1992) Urinary albumin excretion, cardiovascular disease, and endothelial dysfunction in non-insulin-dependent diabetes mellitus. Lancet 340(8815):319–323CrossRefPubMedGoogle Scholar
  22. 22.
    Schoepf UJ, Goldhaber SZ, Costello P (2004) Spiral computed tomography for acute pulmonary embolism. Circulation 109:2160–2167CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Shumei Kato
    • 1
  • Svetlana Chernyavsky
    • 1
  • Joji Erik Tokita
    • 1
  • Yuichi J. Shimada
    • 1
  • Peter Homel
    • 1
  • Herman Rosen
    • 1
  • James F. Winchester
    • 1
  1. 1.Department of Medicine, Beth Israel Medical CenterUniversity Hospital and Manhattan Campus for the Albert Einstein College of MedicineNew YorkUSA

Personalised recommendations