Epidemiology and Pathophysiology of Nephrotic Syndrome-Associated Thromboembolic Disease

被引:256
作者
Kerlin, Bryce A. [1 ,2 ,4 ]
Ayoob, Rose [3 ]
Smoyer, William E. [2 ,3 ,4 ]
机构
[1] Nationwide Childrens Hosp, Div Hematol Oncol & Bone Marrow Transplantat, Columbus, OH 43021 USA
[2] Ohio State Univ, Coll Med, Dept Pediat, Columbus, OH 43210 USA
[3] Nationwide Childrens Hosp, Div Nephrol, Columbus, OH 43021 USA
[4] Nationwide Childrens Hosp, Ctr Clin & Translat Res, Res Inst, Columbus, OH 43021 USA
来源
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY | 2012年 / 7卷 / 03期
关键词
RENAL-VEIN THROMBOSIS; DEFINITE ANTIPHOSPHOLIPID SYNDROME; INTERNATIONAL CONSENSUS STATEMENT; INFERIOR VENA-CAVA; FREE PROTEIN-S; RISK-FACTORS; VENOUS THROMBOEMBOLISM; CLASSIFICATION CRITERIA; MEMBRANOUS NEPHROPATHY; ANTITHROMBOTIC THERAPY;
D O I
10.2215/CJN.10131011
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
After infections, thromboembolism is considered by many experts to be the most significant life-threatening complication of nephrotic syndrome. The purpose of this review is to summarize the epidemiology, clinical and molecular pathophysiology, and management of this complication. Children (2.8%) are less likely than adults (26.7%) with nephrotic syndrome to develop thromboembolism. However, infants and children aged >12 years are at much greater risk. Membranous histologic changes increase thromboembolic risk at all ages; in particular, adults with membranous nephropathy have the highest reported risk (37.0%) and children with membranous histology have a rate (25%) that approaches the overall adult rate. There are striking, but variable, pathologic alterations of molecular hemostasis associated with nephrotic syndrome. No clear molecular therapeutic targets have been identified, but most studies show that the major pathologic changes involve antithrombin, fibrinogen, and factors V and VIII. There is inadequate evidence to support routine prophylactic therapy. Therapy includes anticoagulation in all cases, with thrombolysis reserved for those with the most severe thromboembolic disease. Future hemostatic research in nephrotic syndrome should focus on identifying cohorts at highest risk for thrombosis through the use of clinical markers and biomarkers as well as searching for molecular targets to correct the prothrombotic pathophysiology of this disease. Clin J Am Soc Nephrol 7: 513-520, 2012. doi: 10.2215/CJN.10131011
引用
收藏
页码:513 / 520
页数:8
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