Nephrotic Syndrome and Hypercoagulability
The nephrotic syndrome can induce a hypercoagulable state. In one study of patients with the nephrotic syndrome, thromboembolic events occurred in 5% of children and 44% of adults. The mechanisms for hypercoagulability in the nephrotic syndrome include low levels of antithrombin III, due to increased renal clearance; low functional levels of protein S, due to decreased clearance of the C4-binding protein, which binds to protein S, and increased renal clearance of free protein S; increased plasma levels of factors V, VII, VIII, von Willebrand factor, and fibrinogen; and increased production of Lp(a) lipoprotein by the liver.
Teaching topics from the New England Journal of Medicine - Vol. 358, No. 9, February 28, 2008