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Abstract: TH-PO1052

Nephrotic Syndrome Acquired Hypercoagulopathy Is Strongly Associated with Proteinuria and Hyperlipidemia

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Kerlin, Bryce A., The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, United States
  • Waller, Amanda P., The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, United States
  • Troost, Jonathan P., University of Michigan, Ann Arbor, Michigan, United States
  • Parikh, Samir V., Ohio State University Medical Center, Columbus, Ohio, United States
  • Smoyer, William E., Nationwide Children's Hospital, Columbus, Ohio, United States
  • Kretzler, Matthias, U.Michigan, Ann Arbor, Michigan, United States
Background

Nephrotic syndrome (NS) is complicated by hypercoagulopathy and predilection for venous thromboembolism (VTE). Routine anticoagulant prophylaxis is controversial. Thrombin generation assay (TGA), a measure of hypercoagulopathy, has known predictive value for VTE in non-NS patients. We have shown that TGA is directly proportional to NS severity in animal NS. We sought to determine if TGA is correlated with human NS severity.

Methods

NEPTUNE biorepository plasma aliquots (N=150) were obtained (excluding patients on anticoagulants or with prior VTE) along with phenotypic data. TGA was performed and endogenous thrombin potential (ETP) calculated as the area under the thrombin activity curve. Plasma albumin levels were also determined.

Results

TGA was undetectable in 3 (2%) of the NEPTUNE samples (excluded). Univariate linear regression on the remaining 147 samples revealed significant relationships with: Age (B=-16), Proteinuria (log-UP:C; B=265), Plasma Albumin (B=-657), Total Cholesterol (B=2,129), eGFR (B=10), and Steroid (B=853) or RAAS-blockade (B=-573) treatment. Histologic NS classification was not significantly associated with ETP. Multivariable modeling revealed an interaction between remission status and proteinuria, such that UP:C was independently predictive of ETP in patients with active disease (B=828; P<0.0001; Figure). Age (B=-15; P=0.005) and Total Cholesterol (B=1,448; P=0.0001) were also independently predictive. The final multivariable model was highly correlated with ETP (R2=0.35). Similar NS-severity univariate relationships were demonstrated in our local cohort.

Conclusion

Proteinuria and hyperlipidemia were associated with ETP. These data suggest that analysis of these NS severity markers and ETP in relation to thrombotic events in patients with NS may inform their utility as a future guide to anticoagulant prophylaxis.

Funding

  • NIDDK Support