Department of Pharmacy , Peking University First Hospital, Beijing , China.
Institute of Clinical Pharmacology , Peking University First Hospital, Beijing , China.
J Am Soc Nephrol. 2023 Nov 1;34(11):1793-1811. doi: 10.1681/ASN.0000000000000199. Epub 2023 Jul 24.
The interaction between the kidney and the coagulation system greatly affects each other because of the abundant vessel distribution and blood perfusion in the kidney. Clinically, the risks of complicated thrombosis and bleeding have become important concerns in the treatment of nephropathies, especially nephrotic syndrome, CKD, ESKD, and patients with nephropathy undergoing RRTs. Adverse effects of anticoagulant or procoagulant therapies in patients with nephropathy, especially anticoagulation-related nephropathy, heparin-induced thrombocytopenia, and bleeding, seriously worsen the prognosis of patients, which have become challenges for clinicians. Over the decades, the interaction between the kidney and the coagulation system has been widely studied. However, the effects of the kidney on the coagulation system have not been systematically investigated. Although some coagulation-related proteins and signaling pathways have been shown to improve coagulation abnormalities while avoiding additional kidney damage in certain kidney diseases, their potential as anticoagulation targets in nephropathy requires further investigation. Here, we review the progression of research on the crosstalk between the coagulation system and kidney diseases and systematically analyze the significance and shortcomings of previous studies to provide new sight into future research. In addition, we highlight the status of clinical treatment for coagulation disorder and nephropathy caused by each other, indicating guidance for the formulation of therapeutic strategies or drug development.
肾脏与凝血系统之间的相互作用因肾脏中丰富的血管分布和血液灌注而相互影响。临床上，肾病治疗中复杂血栓形成和出血的风险已成为重要关注点，尤其是肾病综合征、慢性肾脏病、终末期肾病和接受肾脏替代治疗的肾病患者。肾病患者抗凝或促凝治疗的不良反应，特别是抗凝相关性肾病、肝素诱导的血小板减少症和出血，严重恶化了患者的预后，这给临床医生带来了挑战。几十年来，肾脏与凝血系统之间的相互作用已得到广泛研究。然而，肾脏对凝血系统的影响尚未得到系统研究。虽然一些与凝血相关的蛋白质和信号通路已被证明可以改善某些肾脏疾病中的凝血异常，同时避免额外的肾脏损伤，但它们作为肾病抗凝靶点的潜力仍需要进一步研究。在这里，我们综述了凝血系统与肾脏疾病相互作用的研究进展，并系统分析了以往研究的意义和局限性，为未来的研究提供了新的视角。此外，我们还强调了相互作用导致的凝血障碍和肾病的临床治疗现状，为治疗策略的制定或药物开发提供了指导。
