Nephrotic syndrome (NS) is accompanied by a high risk of venous and arterial thrombotic complications due to hypercoagulation. However, routine laboratory tests have insufficient sensitivity to detect hypercoagulation; therefore, integral coagulation assessment tests seem more promising for the hemostasis disorders evaluation in patients with NS.

OBJECTIVE

To characterize hemostasis system abnormalities in patients with chronic glomerulonephritis (CGN) with NS using thromboelastography (TEG).

MATERIAL AND METHODS

Forty-nine CGN patients aged 18 years or older (mean age 37 years), including 25 (51%) females and 24 (49%) males, were included in the study. Twenty (40.8%) patients were diagnosed with NS, and 29 (59.2%) had no NS. The process of clot formation was assessed by TEG with evaluation of R, K, maximum amplitude (MA), coagulation index (CI). The results were compared with routine blood chemistry tests in NS and renal dysfunction, activated partial thromboplastin time, and prothrombin time (PTT).

RESULTS

According to TEG results, a significant decrease of coagulation initiation time (R, min), as well as its correlation with cholesterol and PTT, was observed in GCN patients with NS. In patients with NS, an increase in MA, CI, and a shortening of K time (min) were recorded versus patients without NS. TEG parameters K, MA, and CI significantly correlated with the daily proteinuria, albumin level, and glomerular filtration rate, reflecting the contribution of NS and renal dysfunction to hemostasis disorders.

CONCLUSION

According to TEG results, in CGN patients with NS, an activation of plasma and platelet steps of hemostasis is observed, as evidenced by the shortening of R and increase of MA and CI. These changes correlate with the severity of hypoalbuminemia, hypercholesterolemia, and renal dysfunction in patients with NS.