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Prophylaxis with AT III for thromboembolism in nephrotic syndrome: why should it be done?

  • Nephrology - Case Report
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Abstract

Children with nephrotic syndrome (NS) are at risk for sinovenous and arterial thrombosis, uncommon but serious complications of the nephrotic syndrome. Multiple factors are involved in the hypercoagulable state of patients with NS, for instance, enhanced platelet reactivity and deficiency of antithrombin III due to urinary loss of this protein. We report the case of a 7-year-old girl with relapse of nephrotic syndrome and with a clinical risk for thromboembolic complications, identified by very low AT III and albumin serum levels and high fibrinogen and cholesterol serum levels. However, having symptoms of hypovolemia, she was treated with albumin and diuretics, known risk factors for thrombotic incidents, although these drugs were both administered after prophylactic intravenous antithrombin. There are no randomized controlled clinical trials supporting prophylactic anticoagulation in the management of nephrotic syndrome. Arterial thromboses during nephrotic syndrome has been associated with thrombophilic states and the use of diuretics. It might be advisable to do laboratory monitoring for coagulation profiling and, in children at risk, prophylactic treatment with AT III before administering albumin infusion and diuretics.

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Abbreviations

NS:

Nephrotic syndrome

AT:

Antithrombin

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Authors and Affiliations

  1. Department of Mother-Child and Biology-Genetics, University of Verona, Piazzale L. Scuro, 10, 37134, Verona, Italy

    Marco Zaffanello & Milena Brugnara

  2. Neonatal Intensive Care Unit, University of Cagliari, Cagliari, Italy

    Vassilios Fanos

  3. Transfusion Service, GB Rossi Hospital, Verona, Italy

    Massimo Franchini

Authors
  1. Marco Zaffanello
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  2. Milena Brugnara
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  3. Vassilios Fanos
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  4. Massimo Franchini
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Corresponding author

Correspondence to Marco Zaffanello.

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Zaffanello, M., Brugnara, M., Fanos, V. et al. Prophylaxis with AT III for thromboembolism in nephrotic syndrome: why should it be done?. Int Urol Nephrol 41, 713–716 (2009). https://doi.org/10.1007/s11255-008-9434-8

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  • DOI: https://doi.org/10.1007/s11255-008-9434-8

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