warfarin and Nephrotic-Syndrome

Acute kidney injury in the context of nephrotic syndrome is a serious and alarming clinical problem. Largely, acute kidney injury is a relatively frequent complication among patients with comorbidities while it has been independently associated with an increased risk of adverse outcomes, including death and chronic kidney disease. Nephrotic syndrome, without hematuria or with minimal hematuria, includes a list of certain glomerulopathies; minimal change disease, focal segmental glomerulosclerosis and membranous nephropathy. In the light of primary nephrotic syndrome, pathophysiology of acute kidney injury is differentiated by the nature of the primary disease and the severity of the nephrotic state. This review aims to explore the clinical circumstances and pathogenetic mechanisms of acute kidney injury in patients with nephrotic syndrome due to primary glomerulopathies, focusing on newer perceptions regarding the pathogenesis and management of this complicated condition, for the prompt recognition and timely initiation of appropriate treatment in order to restore renal function to its baseline level. Prompt recognition of the precise cause of acute kidney injury is crucial for renal recovery. Clinical characteristics, laboratory and serological findings along with histopathological findings, if required, will reveal the implicated pathway leading to individualized approach and management.

Topics: Acute Kidney Injury; Anticoagulants; Biopsy; Calcineurin Inhibitors; Glomerulosclerosis, Focal Segmental; Humans; Kidney; Nephritis, Interstitial; Nephrotic Syndrome; Renal Veins; Thrombosis; Warfarin

Congenital nephrotic syndrome (CNS) refers to a disease presenting with massive proteinuria in association with hypoalbuminemia, hyperlipidemia, and edema at birth or within the first three months of life. In the past, most children with CNS had extremely poor prognosis and succumbed to various complications, usually within the first 6 months. Recent advancements in protein supplementation and nutritional support, renal replacement therapy and renal transplantation in infancy, render these patients to have much better outcomes. However, there are still many hurdles in the management of this disease. Thromboembolism is an uncommon, yet important complication which the healthcare givers must be aware of. This article reviews the challenges in the management of the thrombotic complications with special emphasis on the unique characteristics of the newborn hemostasis system and anti-thrombin (AT) depletion in nephrotic syndrome. Due to the relatively low incidence of CNS in children and scarce information in the literature on the optimal management of the thromboembolic complications, most of the recommendations are based on the authors' experience.

Topics: Anticoagulants; Child, Preschool; Hemostasis; Humans; Infant; Infant, Newborn; Kidney Transplantation; Nephrotic Syndrome; Nutrition Therapy; Platelet Aggregation; Platelet Count; Prognosis; Thromboembolism; Warfarin

Over the past 20 years the therapy of glomerulonephritis (GN) has evolved. Today apart from steroids and cyclophosphamide, newer agents like cyclopsorine A and tracrolimus (FK 506) have been reported to achieve remission (partial or complete) in patients with nephrotic syndrome due to various GN which have failed to respond to steroids and cyclophosphamide. For those patients who do not respond to any of the primary therapeutic agents, there are now other therapies available like angiotensin II converting enzyme inhibitors, angiotensin II receptor antagonists, dipyridamole, low dose warfarin including protein restriction and therapy aimed at hypercholesterolaemia in an attempt to retard progression to end stage renal failure. This paper presents a therapeutic approach for the various forms of primary GN.

Topics: Angiotensin II; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Anticoagulants; Cyclophosphamide; Cyclosporine; Dipyridamole; Glomerulonephritis; Humans; Immunosuppressive Agents; Nephrotic Syndrome; Remission Induction; Steroids; Tacrolimus; Vasodilator Agents; Warfarin

Topics: Anticoagulants; Blood Coagulation; Heparin; Humans; Nephrotic Syndrome; Thrombolytic Therapy; Thrombosis; Warfarin

The risk of thromboembolic events is elevated in patients with nephrotic syndrome, and warfarin use has been associated with an increased risk of bleeding. Indobufen, a selective cyclooxygenase-1 inhibitor, is currently being evaluated for the prevention of thromboembolic events in nephrotic syndrome. This study aimed to compare the efficacy and safety of indobufen with that of warfarin in patients with nephrotic syndrome.. This multicenter, randomized, three-arm, open-label, parallel controlled trial involved a total of 180 adult patients with nephrotic syndrome from four centers in China. Patients were randomly assigned to receive 100 mg indobufen (bid), 200 mg indobufen (bid), and 3 mg warfarin (qd) daily for 12 weeks. The primary endpoints included thromboembolic and bleeding events, while laboratory results and adverse events constituted secondary endpoints.. No thromboembolic events occurred in the high-/low-dose indobufen and warfarin groups. Moreover, the use of a low dose of indobufen significantly reduced the risk of minor bleeding events compared with warfarin use (2% versus 18%,. This study found that indobufen therapy provided equivalent effects in preventing thromboembolic events compared with warfarin therapy, while low dose of indobufen was associated with a reduced risk of bleeding events, thus it should be recommended for the prevention of thromboembolic events in clinical practice in patients with nephrotic syndrome.. ChiCTR-IPR-17013428.

Topics: Adult; Anticoagulants; Atrial Fibrillation; Fibrinolytic Agents; Hemorrhage; Humans; Nephrotic Syndrome; Thromboembolism; Treatment Outcome; Warfarin

40 patients with idiopathic membranous glomerulonephritis were randomized to receive either no treatment or a regime of cyclophosphamide for 6 months, and warfarin and dipyridamole for two years. During the two years of the trial there was no significant deterioration in renal function in either group. A significantly greater improvement in urinary protein excretion was, however, observed at all time points in the treatment group. Plasma albumin was also significantly higher in the treatment group at 18 and 24 months. As progressive deterioration in renal function in membranous glomerulonephritis is associated with persistent heavy proteinuria these results suggest a beneficial effect of treatment.

Topics: Cyclophosphamide; Dipyridamole; Drug Administration Schedule; Drug Therapy, Combination; Female; Glomerulonephritis, Membranous; Humans; Kidney Function Tests; Male; Middle Aged; Nephrotic Syndrome; Time Factors; Warfarin

Nine patients with biopsy-proven primary focal and segmental hyalinosis and sclerosis (FSHS) and steroid-resistant nephrotic syndrome were randomly allocated to either a period of 4-6 months of treatment (ciclosporin; (CS); 5-8 mg/kg/24 h and warfarin) or to a control period (warfarin alone) and then crossed over to the alternative for a further 4-6 months. Serum creatinine levels increased at a similar rate during treatment and control periods of observation. Serum albumin levels increased (p less than 0.05) and urinary protein excretion decreased (p less than 0.01) in association with the CS therapy compared to the control period of observation. No patient had complete resolution of the nephrotic syndrome. In primary FSHS, CS treatment is unlikely to produce complete resolution of nephrotic-range proteinuria but does significantly decrease urinary protein excretion.

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Creatinine; Cyclosporins; Drug Resistance; Drug Therapy, Combination; Female; Glomerulonephritis; Glomerulosclerosis, Focal Segmental; Humans; Male; Middle Aged; Nephrotic Syndrome; Proteinuria; Randomized Controlled Trials as Topic; Serum Albumin; Warfarin

Evidence supporting venous thromboembolism (VTE) prophylaxis with direct oral anticoagulants (DOACs) in patients with nephrotic syndrome (NS) is limited to case reports.. The purpose of this study was to compare bleeding and thromboembolic events in this population.. A retrospective cohort study was conducted in adults with NS initiated on a DOAC or warfarin for VTE prophylaxis between January 2013 and July 2021 within the Ochsner Health System. Patients with study drug exposure within the preceding 7 days, acute VTE within the preceding 6 months, or ≤7 days of study drug exposure were excluded. The primary outcome was the composite rate of major bleeding and clinically relevant nonmajor bleeding. Secondary outcomes included time to major bleeding and rate of new thromboembolic events. This study was approved by the Ochsner Health System Institutional Review Board.. Twenty-five DOAC and 19 warfarin patients were included. The primary outcome occurred in 8% vs 26.3% (. Use of DOACs for VTE prophylaxis resulted in a nonstatistically significant, but clinically relevant lower rate of major bleeding compared to warfarin. This study provides comparative data showing safe and effective use of DOACs in patients with NS. Prospective, randomized studies are needed to confirm results.

Topics: Administration, Oral; Adult; Anticoagulants; Humans; Nephrotic Syndrome; Prospective Studies; Retrospective Studies; Venous Thromboembolism; Warfarin

Performing percutaneous renal biopsy procedures in lupus nephritis (LN) and nephrotic syndrome presents a unique challenge to the nephrologist because of the risk of bleeding from the procedure and the hypercoagulable state in hypoalbuminemia. The management of a patient with venous thrombosis with perinephric hematoma post renal biopsy can be difficult if occurred.. We are presenting a case of perinephric hematoma following percutaneous renal biopsy in a 23-year-old man with lupus nephritis, nephrotic syndrome, and lower limbs deep vein thrombosis (DVT). The patient developed persistent frank haematuria, flank pain and acute urinary retention post-procedure. We have withheld his oral warfarin three days before the procedure, and no anticoagulation was given subsequently. Initial CT Angiography (CTA) renal showing stable hematoma and no visible evidence of vascular injury. Three weeks later, the patient still has persistent frank haematuria and a repeated CTA renal revealed new bilateral renal vein thrombosis. Considering the high risk of worsening symptomatic venous thrombosis, we gave subcutaneous enoxaparin sodium and restart oral warfarin despite ongoing haematuria. The frank haematuria resolved within two days of anticoagulation with no radiological evidence of worsening of the perinephric hematoma. The follow-up ultrasonography a month later showed resolution of the hematoma and renal vein thrombosis with no adverse effect.. Our experience, in this case, highlighted the importance of case selection for percutaneous renal biopsy among high-risk patients. Additionally, a prolonged frank haematuria in post-renal biopsy with nephrotic syndrome warranted a reassessment, as a clinical presentation of post-procedure perinephric hematoma and renal vein thrombosis can overlap. We also demonstrated that restarting anticoagulation earlier than four weeks in a patient with renal vein thrombosis and post-renal biopsy perinephric hematoma can be safe in the selective case.

Topics: Adult; Biopsy; Enoxaparin; Gastrointestinal Hemorrhage; Hematoma; Hematuria; Humans; Kidney Diseases; Lupus Nephritis; Male; Nephrotic Syndrome; Renal Veins; Ureteral Diseases; Venous Thrombosis; Warfarin; Young Adult

Congenital nephrotic syndrome (CNS) is an ultra-rare disease associated with a pro-thrombotic state and venous thromboembolisms (VTE). There is very limited evidence evaluating thromboprophylaxis in patients with CNS. This study aimed to determine the doses and duration of treatment required to achieve adequate thromboprophylaxis in patients with CNS.. From 2005 to 2018 children in Scotland with a confirmed genetic or histological diagnosis of CNS were included if commenced on thromboprophylaxis. The primary study endpoint was stable drug monitoring. Secondary outcomes included VTE or significant haemorrhage.. Eight patients were included; all initially were commenced on low-molecular weight heparin (enoxaparin). Four patients maintained therapeutic anti-Factor Xa levels (time 3-26 weeks, dose 3.2-5.07 mg/kg/day), and one patient developed a thrombosis (Anti-Factor Xa: 0.27 IU/ml). Four patients were subsequently treated with warfarin. Two patients maintained therapeutic INRs (time 6-11 weeks, dose 0.22-0.25 mg/kg/day), and one patient had two bleeding events (Bleed 1: INR 6, Bleed 2: INR 5.5).. Achieving thromboprophylaxis in CNS is challenging. Similar numbers of patients achieved stable anticoagulation on warfarin and enoxaparin. Enoxaparin dosing was nearly double the recommended starting doses for secondary thromboprophylaxis. Bleeding events were all associated with supra-therapeutic anticoagulation.

Topics: Anticoagulants; Child; Enoxaparin; Hemorrhage; Humans; Nephrotic Syndrome; Thrombosis; Venous Thromboembolism; Warfarin

Nephrotic syndrome (NS) is associated with increased risk of venous thromboembolism (VTE). Guidelines suggest prophylactic anticoagulants to patients with high risk of thrombosis and low risk of bleeding, but the evidence behind this is poor. This study aims to investigate the effectiveness and risks of prophylactic anticoagulants (PAC) and investigate risk factors for VTE and bleeding in NS.. A retrospective medical records study including adults with NS, biopsy proven glomerular disease in the county of Västernorrland, Sweden. Outcomes were VTE, bleeding and death. Patients divided into PAC- and no PAC group were compared using Fisher's exact test. Patient time was divided into serum/plasma(S/P)-albumin intervals (<20g/L and ≥20g/L) and VTE- and bleeding rates were calculated.. In 95 included NS patients (PAC = 40, no PAC = 55), 7 VTE (7.4%) and 17 bleedings (18%) were found. Outcomes didn't differ significantly between the PAC and no PAC group. Time with S/P-albumin <20g/L conferred higher rates/100 years of VTE (IRR 21.7 (95%CI 4.5-116.5)) and bleeding (IRR 5.0 (1.4-14.7)), compared to time with S/P-albumin>20g/L.. Duration of severe hypoalbuminemia (S/P-albumin <20g/L) in NS is a risk factor for both VTE and bleeding. There is a need for randomized controlled studies regarding the benefit of PAC in NS as well as risk factors of thrombosis and bleeding in NS.

Topics: Adult; Aged; Anticoagulants; Female; Hemorrhage; Heparin, Low-Molecular-Weight; Humans; Kidney; Male; Middle Aged; Nephrotic Syndrome; Retrospective Studies; Risk Factors; Serum Albumin; Severity of Illness Index; Venous Thromboembolism; Warfarin

An increased incidence of thromboembolic events (TE) are reported in nephrotic syndrome (NS) leading to recommendations for prophylactic anticoagulation (PAC). However, as no randomized clinical trial has established the efficacy or risks associated with PAC, guidelines are empiric or substantiated only by estimates of risks and benefits. This study evaluates the risk of TE and hemorrhagic complications in patients with NS treated with PAC and compares to patients not receiving PAC.. We included patients diagnosed with NS from two Danish nephrology departments with different practices for the use of PAC. Patients were included if presenting with NS from September 2006 to January 2012, a P-albumin < 30 g/L, and renal biopsy confirming non-diabetic, glomerular disease. Patients aged < 16 years, on renal replacement therapy, or administered anticoagulants at the onset of NS were excluded. Bleeding episodes and/or TE were identified from patient records. Bleeding episodes were divided into minor and major bleeding.. Of the 79 patients included, 44 patients received PAC either as low or high dose low-molecular-weight heparin (LMWH) or as warfarin with or without LMWH as bridging, while 35 did not receive PAC. P-albumin was significant lower in the PAC group compared to those not receiving PAC. Significantly more TEs was observed in the non-PAC group compared to the PAC group (4 versus 0 episodes, P = 0.035). The TEs observed included one patient with pulmonary embolism (PE), one with PE and deep vein thrombosis, one with PE and renal vein thrombosis, and one with a stroke. Five patients with bleeding episodes were identified among those receiving PAC, of which two were major and three were minor, while two patients in the non-PAC group experienced a minor bleeding episode (P = 0.45 between groups). The major bleeding episodes only occurred in patients receiving PAC in combination with low dose aspirin.. In patients with NS the use of PAC was associated with a decreased risk of clinically significant TE, but may also be associated with more bleeding episodes although not statistically significant. Only patients treated with PAC in combination with anti-platelet therapy had major bleeding episodes.

Topics: Anticoagulants; Biopsy; Chemoprevention; Denmark; Female; Hemorrhage; Heparin, Low-Molecular-Weight; Humans; Kidney; Male; Middle Aged; Nephrotic Syndrome; Risk Assessment; Thromboembolism; Warfarin

Hypercoagulability can lead to thromboembolic events that are a life-threatening complication of nephrotic syndrome (NS). Conventional anticoagulants are first-line treatment in the presence of demonstrated thrombosis in NS. Direct-acting oral anticoagulants (DOACs) have provided useful alternatives for the prevention and treatment of thromboembolic events.. A 59-year-old male developed lower limbs deep vein thrombosis (DVT) during the early course of NS but presented poor response to oral therapeutic doses of rivaroxaban. The decision was made to switch from rivaroxaban to heparin and subsequently bridged to warfarin. The patient presented significant clinical symptom improvement.. NS with Lower limbs DVT.. Rivaroxaban was discontinued and switch to heparin and subsequently bridged to warfarin.. Venography result of both lower limb vein showed the venous wall was smooth without obvious stenosis or obstruction. Edema of the patient's lower limbs gradually improved and disappeared.. The existing published data on the application of DOACs in NS are limited. DOACs have an immediate anticoagulant effect and have demonstrated safety and efficacy and required no routine monitoring, however, application of these agents in NS likely requires further investigation before widespread adoption.

Topics: Anticoagulants; Humans; Male; Middle Aged; Nephrotic Syndrome; Rivaroxaban; Thrombophilia; Venous Thrombosis; Warfarin

A 39-year-old man with nephrotic syndrome was admitted due to right dorsal pain. Contrast-enhanced CT led to a diagnosis of renal vein thrombosis and segmental pulmonary thromboembolism. Treatment with heparin and warfarin was started. After 1 month, pulmonary thromboembolism recurred. Warfarin was switched to edoxaban, and steroid therapy was initiated, which led to the remission of nephrotic syndrome and the disappearance of renal vein thrombosis. The efficacy of edoxaban was demonstrated; however, this drug has not been routinely selected for patients with renal disease. Our results suggest that edoxaban is also effective for treating venous thrombosis patients with nephrotic syndrome.

Topics: Adult; Factor Xa Inhibitors; Heparin; Humans; Male; Nephrotic Syndrome; Pulmonary Embolism; Pyridines; Renal Veins; Thiazoles; Treatment Outcome; Venous Thrombosis; Warfarin

Nephrotic syndrome confers an acquired prothrombotic phenotype due to the urinary loss of anticoagulant proteins.Patients with reactivation of nephrotic syndrome may develop thrombosis.. We report the case of a life-threatening cerebral venous thrombosis in a 13 year-old boy affected by a relapse of nephrotic syndrome during a P. aeruginosa otitis/mastoiditis. Due to the worsening general conditions and the severe neurological impairment, a course of systemic thrombolysis was successfully administered, followed by anticoagulant therapy. In the present case severe inherited thrombophilia (inherited dysfunctional protein S deficiency) was identified as an important additional risk factors for thrombosis.. A careful evalutaion of risk factos for thrombosi during reactivation of nephrotic syndrome include measurement of plasma anticaogulant proteins. When low, antithrombotic prophylaxis with heparin should be considered to prevent thrombotic episodes.

Topics: Adolescent; Anticoagulants; Biopsy; Heparin; Humans; International Normalized Ratio; Intracranial Thrombosis; Magnetic Resonance Angiography; Male; Nadroparin; Nephrotic Syndrome; Pedigree; Protein S Deficiency; Thrombolytic Therapy; Tissue Plasminogen Activator; Warfarin

Topics: Anticoagulants; Blood Coagulation; Brachiocephalic Veins; Child; Chylothorax; Computed Tomography Angiography; Heparin; Humans; Male; Nephrotic Syndrome; Treatment Outcome; Venous Thrombosis; Warfarin

Venous thromboembolism (VTE) occurs in 7%-40% of nephrotic patients. The risk of VTE depends on the severity and underlying cause of nephrotic syndrome. This study investigated the use of low-dose prophylactic anticoagulation to prevent VTE in patients with nephrotic syndrome caused by primary glomerulonephritis.. Since 2006, all patients presenting with nephrotic syndrome to Imperial College Kidney and Transplant Centre have been considered for treatment with a novel anticoagulation prophylaxis regimen. All cases of nephrotic syndrome secondary to primary membranous nephropathy, minimal-change disease, and FSGS over a 5-year period were retrospectively reviewed. Patients with serum albumin<2.0 g/dl received prophylactic-dose low-molecular-weight heparin or low-dose warfarin; patients with albumin levels of 2.0-3.0 g/dl received aspirin, 75 mg once daily. All thrombotic events and bleeding complications were recorded.. A total of 143 patients received the prophylactic anticoagulation regimen. Median follow-up was 154 weeks (range, 30-298 weeks). The cohort had features associated with a high risk of developing VTE; 40% of the cohort had an underlying diagnosis of membranous nephropathy, and the initial median serum albumin was 1.5 g/dl (range, 0.5-2.9 g/dl). No VTE occurred in patients established on prophylaxis for at least 1 week. VTE was diagnosed in 2 of 143 patients (1.39%) within the first week after presentation and starting prophylaxis. In both cases, it is unclear whether the thrombus had developed before or after the start of prophylaxis. One of 143 (0.69%) patients receiving prophylaxis was admitted urgently with gastrointestinal hemorrhage. Two of 143 patients (1.40%) had elective blood transfusions and procedures to manage occult gastrointestinal bleeding. No other bleeding events occurred in patients receiving prophylaxis.. This regimen of prophylactic antiplatelet or anticoagulant therapy appears effective in preventing VTE in nephrotic syndrome, with relatively few hemorrhagic complications.

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Aspirin; Biomarkers; Female; Fibrinolytic Agents; Glomerulonephritis; Hemorrhage; Heparin, Low-Molecular-Weight; Humans; London; Male; Middle Aged; Nephrotic Syndrome; Platelet Aggregation Inhibitors; Retrospective Studies; Risk Assessment; Risk Factors; Serum Albumin; Serum Albumin, Human; Severity of Illness Index; Time Factors; Treatment Outcome; Venous Thromboembolism; Warfarin; Young Adult

Hypercoagulability, resulting in thromboembolic events, can be a life-threatening complication of nephrotic syndrome (NS). Conventional anticoagulants, such as warfarin, have been the standard of care for more than 50 years; however, the availability of target-specific oral anticoagulants (TSOACs) have provided additional options for the treatment and prevention of thromboembolic events. Documented use of the TSOACs in patients with NS and hypercoagulability is currently limited.. We present the case of an 18-year-old young woman with NS and renal vein thrombosis who was readmitted with bilateral pulmonary emboli on therapeutic doses of warfarin, with a goal international normalized ratio of 2.0 to 3.0. The decision was made to transition the patient from warfarin to rivaroxaban, an oral factor Xa inhibitor.. Rivaroxaban was the first of the emerging TSOACs to be FDA approved for both prevention and treatment of venous thromboembolism. With favorable safety and efficacy data compared with warfarin in addition to a predictable pharmacokinetic profile and the lack of requirement of routine monitoring, rivaroxaban provides a useful alternative in this patient population.. While on therapeutic anticoagulation, a patient previously diagnosed with NS and renal vein thrombosis experienced pulmonary emboli on a conventional anticoagulant and was switched to a target-specific oral anticoagulant with documented completion of 6 months of therapy without recurrent thromboembolism.

Topics: Administration, Oral; Adolescent; Anticoagulants; Factor Xa Inhibitors; Female; Humans; International Normalized Ratio; Morpholines; Nephrotic Syndrome; Pulmonary Embolism; Rivaroxaban; Thiophenes; Thrombophilia; Venous Thromboembolism; Warfarin

Patients with nephrotic syndrome are at risk of developing thrombosis in both veins and arteries. Various manifestations in different organs have been reported. Thrombi in heart seen, associated with multiorgan thrombosis have been reported on autopsy earlier, but only once in a living patient with nephrotic syndrome. Here, we report a 13 years old boy with steroid-resistant nephrotic syndrome, who developed an asymptomatic but potentially hazardous large intracardiac thrombus. The child developed nephrotic syndrome at the age of 9 years and had multiple recurrences. At the age of 13 years, he developed myocardial infarction (MI) due to embolism from a large intracardiac thrombus. Later on, he was treated with heparin and warfarin anticoagulation.

Topics: Acute Coronary Syndrome; Adolescent; Adrenal Cortex Hormones; Anterior Wall Myocardial Infarction; Anticoagulants; Coronary Angiography; Coronary Thrombosis; Disease Progression; Echocardiography, Doppler; Electrocardiography; Follow-Up Studies; Heparin; Humans; Male; Nephrotic Syndrome; Rare Diseases; Recurrence; Risk Assessment; Severity of Illness Index; Treatment Outcome; Warfarin

Topics: Acute Kidney Injury; Anti-Inflammatory Agents; Anticoagulants; Biopsy; Cyclophosphamide; Diagnosis, Differential; Female; Heparin, Low-Molecular-Weight; Humans; Immunoglobulin A; Immunosuppressive Agents; Kidney Tubules; Methylprednisolone; Middle Aged; Necrosis; Nephrotic Syndrome; Prednisone; Radiography; Renal Veins; Venous Thrombosis; Warfarin

Topics: Blood Component Transfusion; Child; Fibrinolytic Agents; Headache; Heparin; Humans; Immunosuppressive Agents; Male; Nephrotic Syndrome; Prednisolone; Recurrence; Sinus Thrombosis, Intracranial; Tomography, X-Ray Computed; Treatment Outcome; Warfarin

Topics: Adolescent; Humans; Ischemia; Lower Extremity; Male; Nephrotic Syndrome; Thrombosis; Warfarin

To determine whether treatment guidelines for patients with lower-extremity venous thrombosis (DVT) could be applied to patients with renal vein thrombosis (RVT). The rates of recurrent venous thrombosis and survival for patients with these 2 diseases were compared.. Inception cohort of individuals was identified with their first lifetime incident of RVT. Recurrent thrombosis and survival were compared with those for patients with DVT in a case-control fashion.. All patients with a diagnosis of RVT at Mayo Clinic from 1980 to 2000.. Survival and recurrent venous thrombosis rates were compared with those for patients with DVT. Survival rates were also compared with those for US white residents.. 218 patients (mean age, 55 +/- 19 years) were included (35% women). Malignancy (66%) and nephrotic syndrome (20%) were the most common underlying causes. Warfarin was prescribed for 74 patients (46% with lifelong therapy). During a mean follow-up of 42 +/- 57 months (768 patient-years), there were 8 recurrent venous thrombotic events (1.0/100 patient-years). This recurrence rate was less than that for patients with DVT (P < 0.001). Survival was lower compared with patients with DVT or age- and sex-matched US white residents (P < 0.001). Active malignancy (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.2 to 4.7) and infection (HR, 2.4; 95% CI, 1.4 to 4.0) were associated with poor survival. Survival was influenced positively by warfarin therapy (HR, 0.53; 95% CI, 0.31 to 0.90).. Retrospective nonrandomized study.. RVT represents a distinct clinical entity with unique recurrence and survival rates. The finding of RVT should prompt a thorough evaluation for an underlying renal malignancy. Oral anticoagulation therapy may be associated with a survival advantage.

Topics: Adult; Aged; Anticoagulants; Case-Control Studies; Cohort Studies; Female; Follow-Up Studies; Humans; Kidney Neoplasms; Male; Middle Aged; Multivariate Analysis; Nephrotic Syndrome; Odds Ratio; Recurrence; Renal Veins; Retrospective Studies; Survival Analysis; Survival Rate; United States; Venous Thromboembolism; Venous Thrombosis; Warfarin; White People

Topics: Adult; Anticoagulants; Female; Glucocorticoids; Heparin, Low-Molecular-Weight; Humans; Methylprednisolone; Nephrotic Syndrome; Renal Veins; Retreatment; Thrombolytic Therapy; Treatment Failure; Venous Thrombosis; Warfarin

A 21-year-old man was admitted to Kure National Hospital with nephrotic syndrome in September 1996. He had suffered from an intractable pruritic skin rash and recurrent subcutaneous abscesses caused by the hyperimmunoglobulin E syndrome since the age of 18 months. Renal biopsy gave a diagnosis of membranoproliferative glomerulonephritis. Steroid therapy decreased urinary protein loss and hypoproteinemia, and his pruritic skin rash was improved. Patients with hyperimmunoglobulin E syndrome have a defective immune response, especially to Staphylococcus aureus infection. Continuous antigen stimulation may have caused this patient's renal histological damage as in immune complex glomerulonephritis.

Topics: Adult; Anticoagulants; Biopsy; Diagnosis, Differential; Dilazep; Drug Therapy, Combination; Follow-Up Studies; Glomerulonephritis, Membranoproliferative; Glucocorticoids; Humans; Job Syndrome; Male; Nephrotic Syndrome; Prednisolone; Vasodilator Agents; Warfarin

The authors describe a 46-year-old Japanese woman who had Takayasu's arteritis associated with nephrotic syndrome due to mesangial proliferative glomerulonephritis with crescent. Although a few cases of focal and segmental mesangial proliferative glomerulonephritis associated with Takayasu's arteritis have been reported, nephrotic syndrome has not been reported previously in this situation.

Topics: Anti-Inflammatory Agents; Anticoagulants; Carotid Artery Diseases; Female; Glomerulonephritis, Membranoproliferative; Heparin; Humans; Middle Aged; Nephrotic Syndrome; Prednisolone; Proteinuria; Takayasu Arteritis; Warfarin

Topics: Anticoagulants; Contraindications; Humans; Infant; Male; Nephrotic Syndrome; Pulmonary Embolism; Warfarin

We present a case of diabetic nephrotic syndrome complicated with cerebral embolism in whom two intracardiac thrombi were found in both right and left ventricles without obvious abnormality echocardiographically. Both thrombi regressed after anticoagulant therapy. This represents an intracardiac thrombotic complication of nephrotic syndrome, presumably with hypercoagulable state as the sole mechanism of intracardiac thrombus formation.

Topics: Adult; Anticoagulants; Diabetic Nephropathies; Female; Heart Ventricles; Humans; Intracranial Embolism and Thrombosis; Nephrotic Syndrome; Thrombosis; Ultrasonography; Warfarin

A 16-year-old patient with relapsing nephrotic syndrome had three episodes of deep vein thrombosis after the age of 15 years. An autosomal inherited genetic abnormality of clotting factor V, resistance to activated protein C, was found. The clinical course showed that this resistance and the nephrotic syndrome potentiated each other as risk factors for deep vein thrombosis, and long-term anticoagulation was indicated.

Topics: Adolescent; Antithrombins; Humans; Long-Term Care; Male; Nephrotic Syndrome; Protein C; Recurrence; Thrombophlebitis; Warfarin

Renal vein thrombosis (RVT) was diagnosed in 12 of 60 patients with nephrotic syndrome with CT scan and confirmed by selective renal angiography. Of the 60 patients, 50 had primary glomerulonephritis with various pathological findings and 10 lupus nephritis. CT is valuable in screening renal vein thrombosis. Renal vein and cubital vein blood in the 12 patients were drawn for assay of FDP, AT III, VIIIR: AG, fibrinogen; the results indicated the presence of a state of hypercoagulation. Of these, 7 were given 200,000 units of urokinase (UK) in divided doses into renal vein within one hour and 5,200,000 units UK into renal artery in the same way. Patients also received 2.5mg/d warfarin and 75mg/d persantine. Except for the 3 with focal sclerosis, patients received 40mg/d prednisone. After 1 month CT and blood fibrinogen, FDP, AT III, VIIIR: AG studies were repeated. RVT in patients with intraarterial UK had complete dissolution of their thrombi. Complete dissolution occurred in 2 of the 7 receiving UK by renal vein and there was partial dissolution in the other 5. It seems that intraarterial injection yielded better results. Hypercoagulation state was alleviated in all patients with UK therapy.

Topics: Adult; Female; Humans; Injections, Intra-Arterial; Male; Nephrotic Syndrome; Renal Veins; Thrombolytic Therapy; Thrombosis; Tomography, X-Ray Computed; Urokinase-Type Plasminogen Activator; Warfarin

Topics: Adult; Blood Coagulation; Blood Coagulation Factors; Dipyridamole; Female; Follow-Up Studies; Humans; Male; Nephrotic Syndrome; Renal Artery Obstruction; Thrombolytic Therapy; Thrombosis; Time Factors; Urokinase-Type Plasminogen Activator; Warfarin

Topics: Dipyridamole; Heparin; Humans; Nephrotic Syndrome; Renal Veins; Thrombosis; Urokinase-Type Plasminogen Activator; Warfarin

We have previously suggested that albumin in tubule fluid at concentrations found in the nephrotic syndrome (NS) binds furosemide, thereby diminishing diuretic effect. This mechanism may contribute to diuretic resistance in NS. If this hypothesis is correct, displacement of albumin from furosemide should restore diuretic response in tubule fluid containing albumin. To test this supposition, in vivo loop microperfusion was performed in rats using perfusates containing 6 microM furosemide in the presence or absence of 3.8 microM albumin, or furosemide and albumin to which 12 microM warfarin or 5.4 mM sulfisoxazole had been added. These drugs are inhibitors of albumin-furosemide binding in plasma. Albumin in the perfusate impaired furosemide effect on loop chloride reabsorption (1248 +/- 59 vs. 886 +/- 65 pEq/min; P less than 0.05). Addition of warfarin or sulfisoxazole to perfusate containing albumin normalized furosemide's effect. Neither drug affected furosemide response in the absence of albumin. Dansylsarcosine, a probe that binds albumin at a different site than furosemide, failed to normalize furosemide response in albumin perfusates. These data suggest that albumin in tubule fluid reduces diuretic response through a diminution in the free furosemide concentration. In as much as this mechanism contributes to diuretic resistance observed clinically in NS, displacement of furosemide from albumin binding sites may be a therapeutic strategy warranting study.

Topics: Albumins; Animals; Binding Sites; Binding, Competitive; Body Fluids; Dansyl Compounds; Drug Tolerance; Furosemide; Kidney Tubules, Distal; Male; Nephrotic Syndrome; Perfusion; Protein Binding; Rats; Rats, Inbred Strains; Sarcosine; Sulfisoxazole; Warfarin

Thromboembolic events occur with a frequency of 3-5% in children with nephrotic syndrome (NS). Although numerous abnormalities in all phases of coagulation have been described in NS, the pathogenesis of clotting abnormalities remains poorly understood in this group of patients. We describe a child with long-standing NS in whom a severe deep venous thrombosis and pulmonary embolism secondary to acquired protein S deficiency and a strong lupus-type circulating anticoagulant developed. In addition, this patient had a markedly decreased plasma level of C4b binding protein. Although acquired protein S deficiency has been described in various clinical disorders including NS, our patient is unusual in having C4bBP deficiency, and his is the only reported pediatric case of NS complicated by thromboembolism in which a circulating anticoagulant has been implicated, to our knowledge.

Topics: Autoimmune Diseases; Carrier Proteins; Child; Complement Inactivator Proteins; Drug Eruptions; Drug Therapy, Combination; Glomerulonephritis, Membranous; Glycoproteins; Heparin; Humans; Lupus Coagulation Inhibitor; Male; Methylprednisolone; Necrosis; Nephrotic Syndrome; Phospholipids; Prednisone; Protein S; Pulmonary Embolism; Thrombolytic Therapy; Thrombophlebitis; Urokinase-Type Plasminogen Activator; Warfarin

Topics: Cyclophosphamide; Digitalis; Furosemide; Glomerulonephritis; Humans; Nephrotic Syndrome; Plants, Medicinal; Plants, Toxic; Prednisolone; Warfarin

The behavior of warfarin, a drug tightly bound to albumin, was studied in patients with nephrotic syndrome (NS) to assess the influence of hypoalbuminemia on its pharmacokinetics and its effect on vitamin K-dependent coagulation factors. A single dose of warfarin (8 mg) was given orally to 11 nephrotic patients with normal or nearly normal renal function and to 11 controls. In every subject the following measurements were performed: albuminemia before (t0) warfarin administration; plasma warfarin and vitamin K-dependent coagulation factors (FII, FVII, FIX, FX) levels, before and at time intervals from 0 to 48 h after drug administration; warfarin urinary excretion from 0 to 24 h. Urinary warfarin excretion was null in 19 out of the 22 subjects and very low in two nephrotic patients and in one control. Low serum albumin in NS patients induced a twofold increase of unbound warfarin vs controls (3.5% vs 1.8%, p less than 0.001) which led to a threefold increase in plasma clearance of warfarin (9.70 vs 3.26 ml X min-1, p less than 0.001); as warfarin distribution volume showed only a slight (non significant) increase in NS patients, the elimination half-life was thus markedly shortened in NS patients vs controls (18 vs 36 h, p less than 0.01). Maximum warfarin effect on vitamin K-dependent factor levels occurred at 18 h in controls and 24 h in nephrotics, and these lowest values were similar, in spite of a higher level at 0 in NS patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Blood Coagulation Factors; Factor IX; Factor VII; Factor X; Female; Humans; Kinetics; Male; Middle Aged; Nephrotic Syndrome; Prothrombin; Serum Albumin; Vitamin K; Warfarin

An increased sialic acid content of the fibrinogen molecule is found in foetal fibrinogen and as an acquired disorder in hepatic disease. A qualitatively abnormal fibrinogen was detected in the plasma of a 25-year-old man with a thrombotic tendency. The purified fibrinogen had a significantly increased content of sialic acid, an abnormal fibrin monomer polymerization, and a changed mobility in crossed affinity-immunoelectrophoresis using immobilized helix pomatia lectin. The patient had no biochemical or clinical signs of liver disease. The occurrence of a thrombotic tendency and an increased fibrinogen sialic acid content without signs of liver disease may represent a new variant of congenital dysfibrinogenaemia.

Topics: Adult; alpha-Macroglobulins; Fibrinogen; Fibrinogens, Abnormal; Haptoglobins; Humans; Male; N-Acetylneuraminic Acid; Nephrotic Syndrome; Renal Veins; Sialic Acids; Thrombosis; Warfarin

Topics: Azathioprine; Chlorambucil; Cyclophosphamide; Dipyridamole; Glomerulonephritis; Glomerulosclerosis, Focal Segmental; Humans; Kidney Diseases; Kidney Glomerulus; Nephritis; Nephrosis, Lipoid; Nephrotic Syndrome; Prednisone; Warfarin

Topics: Adolescent; Cyclophosphamide; Dipyridamole; Glomerulonephritis; Glomerulosclerosis, Focal Segmental; Humans; Nephritis; Nephrotic Syndrome; Steroids; Warfarin

Diagnosis of renal vein thrombosis, a disease of subtle or dramatic onset, depends largely on clinical suspicion confirmed by renal venography. The principles of management are changing as diagnostic advances resolve the "chicken-or-egg" quandary over the causal relationship between renal vein thrombosis and the nephrotic syndrome.

Topics: Acute Disease; Adult; Child; Chronic Disease; Heparin; Humans; Infant; Nephrotic Syndrome; Phlebography; Renal Veins; Thrombosis; Warfarin

Long-term anticoagulation therapy was evaluated in two patients with renal vein thrombosis and the nephrotic syndrome. Neither patient exhibited peripheral thromboemboli. Moreover, the renal vein thrombus resolved in both cases after eight months on a regimen of oral anticoagulant therapy. Glomerular filtration rate remained stable despite persistence of the nephrotic syndrome. These results suggest that long-term anticoagulation may be of distinct value in nephrotic patients with renal vein thrombosis.

Topics: Aged; Humans; Male; Nephrotic Syndrome; Renal Veins; Thrombosis; Warfarin

Topics: Adult; Anticoagulants; Blood Coagulation; Female; Heparin; Humans; Male; Middle Aged; Nephritis; Nephrotic Syndrome; Warfarin

Topics: Adolescent; Adult; Aged; Biopsy; Cyclophosphamide; Female; Fluorescent Antibody Technique; Humans; Hypertension; Kidney Glomerulus; Male; Microscopy, Electron; Middle Aged; Nephrotic Syndrome; Prednisone; Pyuria; Sclerosis; Warfarin

Topics: Acute Disease; Adolescent; Adult; Aortography; Chronic Disease; Colitis, Ulcerative; Female; Heparin; Humans; Klinefelter Syndrome; Male; Middle Aged; Nephrotic Syndrome; Phlebography; Renal Veins; Thromboembolism; Thrombophlebitis; Thrombosis; Urography; Warfarin

Topics: Adolescent; Adult; Azathioprine; Biopsy; Blood Urea Nitrogen; Child; Complement System Proteins; Creatinine; Diuretics; Female; Glomerulonephritis; Heparin; Humans; Kidney Glomerulus; Male; Nephrotic Syndrome; Prednisone; Prognosis; Warfarin

Topics: Adolescent; Anticoagulants; Child; Complement System Proteins; Female; Glomerulonephritis; Granulomatosis with Polyangiitis; Heparin; Humans; Kidney Diseases; Male; Nephrosis; Nephrotic Syndrome; Proteinuria; Purpura; Warfarin

Topics: Drug Eruptions; Drug Hypersensitivity; Myocardial Infarction; Nephrotic Syndrome; Phenindione; Pulmonary Embolism; Statistics as Topic; Stomatitis; Toxicology; Warfarin