Abstract
Extract: Because of the susceptibility to thromboembolism exhibited by patients with the nephrotic syndrome, the fibrinolytic systems of 27 affected patients were studied and compared with those of 53 patients with other renal disorders; 26 normal subjects were used as controls. Three of the nephrotic patients had thromboembolic episodes. Patients with the nephrotic syndrome had markedly elevated levels of the antiplasmin, α-2-macroglobulin (mean 1290 mg/100 ml), as determined by an immunological radial diffusion assay, when compared with normal controls (mean 270 mg/100 ml) and with other patients with chronic renal disease (mean 380 mg/100 ml). High levels of α-2-macroglobulin in the serum were directly related to increased measured values of serum antiplasmin (antifibrinolysin) activity. These abnormalities persisted, to a lesser degree, during remission of idiopathic nephrotic syndrome.
Plasminogen (profibrinolysin) levels, as determined by radial diffusion, were reduced in idiopathic nephrotic syndrome (mean 62% of adult normal), including the three patients with thromboembolic episodes. Levels of α-1 -antitrypsin, a slow-acting antiplasmin, were neither altered in the nephrotic syndrome nor correlated with antiplasmin activity. Low levels of serum albumin were correlated with high α-2-macroglobulin concentrations. Nine patients, all with the nephrotic syndrome and including the three patients with thromboembolism, had both elevated levels of α-2-macroglobulin and antifibrinolysin activity and decreased levels of plasminogen.
Speculation: The elevated α-2-macroglobulin level and decreased plasminogen activity in patients with the nephrotic syndrome may result in defective fibrinolysis and thromboembolic complications. Prospective studies will be necessary to determine if these measurements have predictive value in determining risk of thromboembolism. The therapy of the nephrotic syndrome should be evaluated not only for its effect on the disease, but also for its effect on the fibrinolytic system.
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Scheinman, J., Stiehm, E. Fibrinolytic Studies in the Nephrotic Syndrome. Pediatr Res 5, 206–212 (1971). https://doi.org/10.1203/00006450-197105000-00003
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DOI: https://doi.org/10.1203/00006450-197105000-00003
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