Correlation of serum level of albumin with platelet count and platelet aggregation assessed by adenosine diphosphate agonist in children with nephrotic syndrome
Abstract
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.
References
Eddy AA, Symons JM. Nephrotic syndrome in childhood. Lancet. 2003;362:629–39. https://doi.org/10.1016/S0140-6736(03)14184-0
Wirya IGNW. Penelitian beberapa aspek klinis dan patologi anatomis sindrom nefrotik primer pada anak di Indonesia. Jakarta: FKUI; 1992. p.12-5.
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. https://doi.org/10.1002/pbc.23388 PMid:22038730 PMCid:PMC3270120
Zaffanello M, Franchini M. Thromboembolism in childhood nephrotic syndrome: a rare but serious complication. Hematology. 2007;12:69–73. https://doi.org/10.1080/10245330600940048 PMid:17364996
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
Eneman B, Levtchenko E, van den Heuvel B, Van Geet C, Freson K. Platelet abnormalities in nephrotic syndrome. Pediatr Nephrol. 2016;31:1267–79. https://doi.org/10.1007/s00467-015-3173-8 PMid:26267676
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. https://doi.org/10.7860/JCDR/2013/5488.3229
Wirawan R. Nilai rujukan pemeriksaan agregasi trombosit dengan adenosin difosfat pada orang Indonesia dewasa normal di Jakarta. Maj Kedokt Indon. 2007;57:212–9.
Choi JL, Li S, Han JY. Platelet function tests: a review of progresses in clinical application. Biomed Res Int. 2014;2014:456569. https://doi.org/10.1155/2014/456569 PMid:24895576 PMCid:PMC4034486
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. https://doi.org/10.2215/CJN.04250511 PMid:22076873 PMCid:PMC3265338
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. https://doi.org/10.1093/ndt/gfw227 PMid:28391310 PMCid:PMC6251635
Andolino TP, Reid-Adam J. Nephrotic syndrome. Pediatr Rev. 2015;36:117–25. https://doi.org/10.1542/pir.36-3-117 PMid:25733763
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.
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. https://doi.org/10.1111/jth.12891 PMid:25758343
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. https://doi.org/10.1159/000188254 PMid:7830855
Tkaczyk M, Baj Z. Surface markers of platelet function in idiopathic nephrotic syndrome in children. Pediatr Nephrol. 2002;17:673–7. https://doi.org/10.1007/s00467-002-0865-7 PMid:12185480
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. https://doi.org/10.1007/s00467-004-1620-z PMid:15490251
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. https://doi.org/10.3109/0886022X.2014.883931 PMid:24512186
Hafni A, Hilmanto D, Rachmadi D, Sekarwana N. Trombocytosis in childhood relapsing nephrotic syndrome. Paediatr Indones. 2007;47:100–3. https://doi.org/10.14238/pi47.3.2007.100-3
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. https://doi.org/10.1161/CIRCULATIONAHA.107.716951 PMid:18158362
Limantara VL, Mudita IB, Suarta IK. Fibrinogen status in relapse and remission of childhood nephrotic syndrome. Paediatr Indones. 2006;46:149–153. https://doi.org/10.14238/pi46.4.2006.149-53
Copyright (c) 2019 Andar Laura Nainggolan, Sri Sudarwati, Dany Hilmanto
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
Accepted 2019-02-06
Published 2019-02-08
