[Natural coagulation inhibitors; antithrombin III, protein C, protein S in children with hypercoagulation due to nephrotic syndrome].

UNLABELLED

Activity of AT HI, protein C and protein S was evaluated in 58 children with nephrotic syndrome aged between 2-17 years and in 50 healthy children aged between 2-16 years serving as a control group. In children with nephrotic syndrome measurements were conducted at three different stages of disease: onset, improvement and remission. The aim was to assess the effect of steroid therapy on activity of the above inhibitors.

RESULTS

At the onset of the disease, activity of AT III and protein S were found to be significantly decreased whereas activity of protein C was significantly increased as compared with the control group. Activity of AT III lowered at the onset of the disease, was significantly higher during both the improvement and the remission stage. Activity of protein C, increased at the onset of the nephrotic syndrome, decreased progressively and significantly during the improvement stage and then again increased markedly during the remission. Activity of protein S, lowered at the onset and during the improvement stage of the nephrotic syndrome, significantly rose during the remission, but never reached levels observed in the control group. Activity of AT III and protein C within 72 hours after introduction of steroids increased without any marked alterations in the clinical and biochemical course of the nephrotic syndrome. Activity of protein S was not changed.

CONCLUSIONS

There are marked changes in AT III and protein C activity in children with nephrotic syndrome. It is expected that these proteins are involved in inhibition of the inflammatory process and of the local and systemic coagulopathy. Raised activity of protein C is not accompanied by increased activity of protein. This arouses doubts as to whether protein C-protein S complex is effective in inhibition of inflammation and limitation of coagulopathy. That role may be played AT III, which with its sufficient rise at the early stage of treatment may limit the risk of thromboembolic complications in children with nephrotic syndrome.