Photo Credit: Md Babul Hosen

A study of more than 300 patients finds that the risk for thromboembolic events remains high in patients with nephrotic syndrome and relatively high albumin.

Determining thromboembolic risk in patients with nephrotic syndrome (NS) is important to help clinicians make decisions on preventive strategies. Low albumin level is a risk factor for thromboembolic events in NS, and current prophylactic anticoagulation indications mainly focus on low serum albumin levels (<25 g/L). Yet, a gap exists regarding the proportion and characteristics of patients with high serum albumin levels.

Findings published in BMC Nephrology show that the development of thromboembolic events remains a high risk in patients with NS and relatively high albumin levels.

“Our findings could help with clinical decision-making regarding prophylactic anticoagulation,” the researchers wrote.

Study Parameters

The study enrolled 312 hospitalized patients diagnosed with NS and experienced relevant thromboembolic events over 10 years (2012 to 2022). If a patient had proteinuria greater than 3.5 g/day with a serum albumin level less than 30 g/L or had a previous diagnosis of NS before a hospital stay, then an NS diagnosis was made.

Patients were divided into two groups based on their serum albumin level when the thromboembolic event occurred. The most common events between the two groups were pulmonary embolism, deep venous thrombosis, and renal venous thrombosis.

In the entire study cohort, 84 patients (26.9%) had relatively high albumin levels (≥25 g/L). Both groups had similar clinical characteristics and coagulation parameters, except for 24-hour proteinuria. The high-albumin group had a significantly lower level of 24-hour proteinuria versus the low-albumin group (6.7 ±4.9 vs 11.4 ±6.8 g/24 hour, respectively; P<0.01). Additionally, patients with NS in the high-albumin group compared with the low-albumin group had a significantly higher rate of autoimmune disease (11.9% vs 3.5%, respectively; P=0.03) and positive lupus anticoagulant (9.5% vs 2.2%, respectively; P=0.03).

Patients with thromboembolic events, regardless of their albumin level, commonly have membranous nephropathy as the underlying pathological type of NS. The authors noted that significantly fewer patients with anti-PLA2R-positive membranous nephropathy were found in the high-albumin group compared with the low-albumin group (P<0.01).

“Our study found that there is still a high risk in patients with NS and relatively high albumin levels to develop thromboembolic events,” the researchers wrote. “During remission of [membranous nephropathy], there is still a risk for thromboembolic events. Therefore, adequate screening and prevention may be necessary for these patients.”