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Research progress of nephrotic syndrome accompanied by thromboembolism

  • Nephrology - Review
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Abstract

Thromboembolism (TE) is a common and serious complication of nephrotic syndrome (NS). NS is associated with hypercoagulability, which may be induced by changes in coagulation, anticoagulant, and fibrinolytic factors. Moreover, accumulating evidence supports the hypothesis that the complex interactions between genetic and acquired risk factors in TE should be considered and that genetic susceptibility should not be ignored. Extracellular vesicles (EVs) also play unique roles. Further research on EVs may provide new insights into the discovery and treatment of TE associated with NS. The occurrence of NS accompanied by TE may be associated with various risk factors. Preventive anticoagulant therapy can not only reduce the risk of TE in patients but also aggravate the risk of bleeding. Heparin and vitamin K antagonists (VKAs), traditional anticoagulant drugs, have been extensively applied in the prevention and treatment of thromboembolic diseases, and emerging direct oral anticoagulants (DOACs) also provide an alternative choice. Owing to the particularity of NS, the safe application of DOACs still needs to be addressed. This review aimed to comprehensively describe the pathophysiology of TE in NS, as well as analyze the associated risk factors, the opportunity for preventive anticoagulation, and current anticoagulant information.

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Data availability is not applicable to this article as no new data were created or analyzed in this study.

Abbreviations

AT-III:

Antithrombin-III

BMI:

Body mass index

C4BP:

C4B binding protein

CKD:

Chronic kidney disease

CT:

Computed tomography

DOACs:

Direct oral anticoagulants

DVT:

Deep vein thrombosis

EVs:

Extracellular vesicles

Gla:

γ-Carboxyglutamic acid

IMN:

Idiopathic membranous nephropathy

INR:

International Standardized ratio

Lp (a):

Lipoprotein (a)

MN:

Membranous nephropathy

MPs:

Microparticles

NS:

Nephrotic syndrome

NOACs:

Novel/new oral anticoagulants

PAC:

Preventive anticoagulation

PAI:

Plasminogen activator inhibitor

PCC:

Prothrombin complex concentrate

PD:

Pharmacodynamics

PE:

Pulmonary embolism

PLG:

Plasminogen

PK:

Pharmacokinetics

PS:

Phosphatidylserine

PT:

Prothrombin time

RVT:

Renal venous thrombosis

TxA2:

Thromboxane A2

TE:

Thromboembolism

TF:

Tissue factor

TFPI:

Tissue factor pathway inhibitor

VKAs:

Vitamin K antagonists

VTE:

Venous thromboembolism

LMWH:

Low-molecular-weight heparin

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Acknowledgements

YJT thanks Prof. GDS and BCS for their constant encouragement, suggestions and support throughout.

Funding

No funding was received to assist with the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin, China

    Yajing Tian, Baichao Sun & Guangdong Sun

  2. Department of Pediatric Nephrology, The First Hospital of Jilin University, Changchun, Jilin, China

    Baichao Sun

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TYJ drafted the manuscript. GDS and BCS contributed to draft reviewing and critical modifications. All authors had carefully read and approved the final manuscript.

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Correspondence to Guangdong Sun.

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Tian, Y., Sun, B. & Sun, G. Research progress of nephrotic syndrome accompanied by thromboembolism. Int Urol Nephrol 55, 1735–1745 (2023). https://doi.org/10.1007/s11255-023-03474-8

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