Coagulation profile in children with idiopathic nephrotic syndrome- A cross-sectional study

Abstract

Background: In children, Idiopathic Nephrotic Syndrome (NS) is a very common kidney disease. Massive proteinuria with high urinary protein-creatinine ratio is typical laboratory finding. Apart from it hypoalbuminemia, hypercholesterolemia and hypovolemia contribute to hypercoagulable states. In children and adults, the risk of thromboembolism is significant. Objective: To determine the coagulation profile among the children with idiopathic nephrotic syndrome. Methodology: This cross-sectional study was done at the Department of Paediatrics, Dhaka Medical College Hospital, from October 2018 to September 2019 and a total 52 subjects were enrolled. Fifteen cases were initial attack and thirty-seven were relapse cases selected by purposive sampling technique. Prothrombin time (PT), activated partial thromboplastin time (APTT), total platelet count (TPC), serum albumin, serum total cholesterol and protein- creatinine ratio were performed. Data were collected, recorded and analysed by SPSS. Result: In this study mean age of the children was 5.0±2.44 year. 73% subjects were in 2-6 years age group with male to female ratio being 1.4:1. Increased platelet count (>400000/mm3), prolonged PT (>16 sec) and APTT (>36 sec) were more in relapse cases than in initial attack cases (76% vs. 24%, p<0.001; 3% vs. 0%, p 0.52 and 14% vs. 0%, p 0.13 respectively). The Mean±SD of platelet count was significantly higher in relapse cases than initial attack cases (466081±175989 vs. 352066±103378/mm3, p 0.023). In relapse cases APTT showed significant positive correlation with protein-creatinine ratio (p <0.001) and negatively with s. albumin (p <0.025).  Conclusion: Hypercoagulable state is more prone to develop in relapse cases than in initial attack cases. So, early detection is important to avoid related complications.