Tarragón Blanca, Han Heedeok, Navarro-Torres Mariela, Canetta Pietro, Wooden Benjamin, Derebail Vimal K, Glenn Dorey, Mottl Amy, Massicotte-Azarniouch David, Kerlin Bryce, Hladunewich Michelle, Coppock Gaia, Rheault Michelle, Mariani Laura H, Bomback Andrew
Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, NY, USA.
UNC Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Clin Kidney J. 2025 Apr 15;18(5):sfaf104. doi: 10.1093/ckj/sfaf104. eCollection 2025 May.
Adult and paediatric patients with nephrotic syndrome (NS) due to different glomerular diseases are at a higher risk of thromboembolic events than the general population, but the use of prophylactic anticoagulation (PAC) among them has not been well described. Although the 2021 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines offer an algorithm to guide the management of PAC, the degree of implementation in practice is unknown.
We evaluated thromboprophylaxis management in patients with NS secondary to membranous nephropathy, focal segmental glomerulosclerosis, minimal change disease and C1q nephropathy enrolled in the Cure Glomerulonephropathy (CureGN) cohort study (diagnosed 2010-2023) and assessed the concordance or discordance with the 2021 KDIGO guidelines practice points in adults. We also analysed thrombotic and bleeding events.
Among 374 adult and 263 paediatric NS episodes, PAC was prescribed in 21 (6%) and 11 (4%) episodes, respectively. In adults, PAC prescription was associated with a history of prior thrombosis, lower serum albumin and higher proteinuria, with coumarins and direct oral anticoagulants (DOACs) being equally the most prescribed agents. In adults, anticoagulation management was concordant with guidelines in 180 (48%) episodes, discordant in 59 (16%) and indeterminate in 135 (36%). Most (92%) guideline-discordant episodes were cases with a high thrombotic risk and low bleeding risk where PAC was not prescribed. In children, PAC prescription was associated with lower albuminaemia and worse kidney function, with heparins being the only agent used. Thrombotic events occurred during 5 (1.3%) and 4 (1.5%) of all adult and paediatric NS episodes, respectively.
PAC was used more conservatively than guidelines suggest and was mainly driven by hypoalbuminaemia severity in both adults and children. Although not included in the guidelines practice points, DOACs were used as often as coumarins in adults.
由于不同肾小球疾病导致的成人和儿童肾病综合征（NS）患者发生血栓栓塞事件的风险高于普通人群，但其中预防性抗凝（PAC）的使用情况尚未得到充分描述。尽管2021年改善全球肾脏病预后（KDIGO）指南提供了指导PAC管理的算法，但在实际中的实施程度尚不清楚。
我们评估了参与肾小球肾炎治愈（CureGN）队列研究（2010 - 2023年诊断）的膜性肾病、局灶节段性肾小球硬化症、微小病变病和C1q肾病继发NS患者的血栓预防管理，并评估了与2021年KDIGO成人指南实践要点的一致性或不一致性。我们还分析了血栓形成和出血事件。
在374例成人和263例儿童NS发作中，分别有21例（6%）和11例（4%）开具了PAC。在成人中，PAC处方与既往血栓形成病史、较低的血清白蛋白和较高的蛋白尿有关，香豆素类和直接口服抗凝剂（DOACs）是最常开具的药物。在成人中，抗凝管理在180例（48%）发作中与指南一致，59例（16%）不一致，135例（36%）不确定。大多数（92%）与指南不一致的发作是高血栓形成风险和低出血风险且未开具PAC的病例。在儿童中，PAC处方与较低的白蛋白血症和较差的肾功能有关，肝素是唯一使用的药物。在所有成人和儿童NS发作中，分别有5例（1.3%）和4例（1.5%）发生了血栓形成事件。
PAC的使用比指南建议更为保守，主要由成人和儿童低白蛋白血症的严重程度驱动。尽管未包含在指南实践要点中，但在成人中DOACs的使用频率与香豆素类相同。
