Correlation of serum level of albumin with platelet count and platelet aggregation assessed by adenosine diphosphate agonist in children with nephrotic syndrome

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Andar Laura Nainggolan
Sri Sudarwati
Dany Hilmanto


Background Nephrotic syndrome (NS) is the most common renal disease among children, and contributes to life-threatening complications such as thromboembolic disease. Platelets are considered to be important agents in thrombotic events among NS patients. The gold standard assessment for platelet aggregation is the use of adenosine diphosphate (ADP) agonist, however, it is expensive and not accessible in smaller health facilities. Thus, other thrombosis parameters are needed. Previous studies suggested that low albumin increased the risk of thrombosis in NS patients.

Objective To assess for a possible correlation between albumin level and platelet count as well as platelet aggregation.

Methods This cross-sectional study was conducted in children with nephrotic syndrome who were admitted to the Pediatric Nephrology Department in Dr. Hasan Sadikin General Hospital, Bandung, West Java, from November 2017 to March 2018. Subjects were selected by consecutive sampling. Serum albumin, platelet count, and platelet aggregation were measured. Statistical analysis was conducted by Spearman’s test.

Results A total of 32 patients participated in the study, with mean age of 109 (SD 7.4) months. Most subjects were male (56%). Subjects’ mean serum albumin level was 2.06 (SD 1.23) g/dL; mean platelet count was 453,062.5 (SD 187,443.90)/mm3; and mean platelet aggregation values for ADP agonist concentrations of 10, 5, 2.5, and 1 mM were 86.8 (SD 8.63)%, 82.4 (SD 15.33)%, 66.6 (SD 24.90)%, 34.95 (SD 31.69)%, respectively. Partial correlation analysis revealed significant negative associations between albumin and platelet count as well as platelet aggregation assessed with 1 mM of ADP concentration (P<0.001), with Spearman correlation coefficients of -0.641 and -0.634, respectively.

Conclusion Serum albumin level had a moderately negative correlation with platelet count and platelet aggregation value.

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How to Cite
Nainggolan A, Sudarwati S, Hilmanto D. Correlation of serum level of albumin with platelet count and platelet aggregation assessed by adenosine diphosphate agonist in children with nephrotic syndrome. PI [Internet]. 8Feb.2019 [cited 24Apr.2019];59(1). Available from:
Pediatric Nephrology


1. Eddy AA, Symons JM. Nephrotic syndrome in childhood. Lancet. 2003;362:629–39.
2. Wirya IGNW. Penelitian beberapa aspek klinis dan patologi anatomis sindrom nefrotik primer pada anak di Indonesia. Jakarta: FKUI; 1992. p.12-5.
3. Setty BA, O'Brien SH, Kerlin BA. Pediatric venous thromboembolism in the United States: a tertiary care complication of chronic diseases. Pediatr Blood Cancer. 2012;59:258–64. PMid:22038730 PMCid:PMC3270120
4. Zaffanello M, Franchini M. Thromboembolism in childhood nephrotic syndrome: a rare but serious complication. Hematology. 2007;12:69–73. PMid:17364996
5. Lau KK, Chan HH, Massicotte P, Chan AK. Thrombotic complications of neonates and children with congenital nephrotic syndrome. Curr Pediatr Rev. 2014;10:169–76. PMid:25088336
6. Eneman B, Levtchenko E, van den Heuvel B, Van Geet C, Freson K. Platelet abnormalities in nephrotic syndrome. Pediatr Nephrol. 2016;31:1267–79. PMid:26267676
7. Mittal A, Aggarwal KC, Saluja S, Aggarwal A, Sureka B. Platelet functions and coagulation changes in Indian children with nephrotic syndrome. J Clin Diagn Res. 2013;7:1647–50.
8. Wirawan R. Nilai rujukan pemeriksaan agregasi trombosit dengan adenosin difosfat pada orang Indonesia dewasa normal di Jakarta. Maj Kedokt Indon. 2007;57:212–9.
9. Choi JL, Li S, Han JY. Platelet function tests: a review of progresses in clinical application. Biomed Res Int. 2014;2014:456569. PMid:24895576 PMCid:PMC4034486
10. Lionaki S, Derebail VK, Hogan SL, Barbour S, Lee T, Hladunewich M, et al. Venous thromboembolism in patients with membranous nephropathy. Clin J Am Soc Nephrol. 2012;7:43–51. PMid:22076873 PMCid:PMC3265338
11. Gyamlani G, Molnar MZ, Lu JL, Sumida K, Kalantar-Zadeh K, Kovesdy CP. Association of serum albumin level and venous thromboembolic events in a large cohort of patients with nephrotic syndrome. Nephrol Dial Transplant. 2017;32:157–64. PMid:28391310 PMCid:PMC6251635
12. Andolino TP, Reid-Adam J. Nephrotic syndrome. Pediatr Rev. 2015;36:117–25. PMid:25733763
13. Alatas H, Tambunan T, Trihono PP, Pardede SO. Konsensus tata laksana sindrom nefrotik idiopatik pada anak. 2nd ed. Jakarta: Badan Penerbit Ikatan Dokter Anak Indonesia; 2012. p. 2-3.
14. Eneman B, Freson K, van den Heuvel L, van Hoyweghen E, Collard L, Vande Walle J, et al. Pituitary adenylate cyclase-activating polypeptide deficiency associated with increased platelet count and aggregability in nephrotic syndrome. J Thromb Haemost. 2015;13:755–67. PMid:25758343
15. Andre E, Voisin P, Andre JL, Briquel ME, Stoltz JF, Martinet N, et al. Hemorheological and hemostatic parameters in children with nephrotic syndrome undergoing steroid therapy. Nephron. 1994;68:184–91. PMid:7830855
16. Tkaczyk M, Baj Z. Surface markers of platelet function in idiopathic nephrotic syndrome in children. Pediatr Nephrol. 2002;17:673–7. PMid:12185480
17. Wasilewska AM, Zoch-Zwierz WM, Tomaszewska B, Biernacka A. Platelet-derived growth factor and platelet profiles in childhood nephrotic syndrome in children. Pediatr Nephrol. 2005;20:36–41. PMid:15490251
18. Gulleroglu K, Yazar B, Sakalli H, Ozdemir H, Baskin E. Clinical importance of mean platelet volume in children with nephrotic syndrome. Ren Fail. 2014;36:663–5. PMid:24512186
19. Hafni A, Hilmanto D, Rachmadi D, Sekarwana N. Trombocytosis in childhood relapsing nephrotic syndrome. Paediatr Indones. 2007;47:100–3.
20. Mahmoodi BK, ten Kate MK, Waanders F, Veeger NJGM, Brouwer JL, Vogt L, et al. High absolute risks and predictors of venous and arterial thromboembolic events in patients with nephrotic syndrome. results from a large retrospective cohort study. Circulation. 2008;117:224–30. PMid:18158362
21. Limantara VL, Mudita IB, Suarta IK. Fibrinogen status in relapse and remission of childhood nephrotic syndrome. Paediatr Indones. 2006;46:149–153.