HEMORHEOLOGICAL AND HEMOSTATIC PARAMETERS IN CHILDREN WITH NEPHROTIC SYNDROME UNDERGOING STEROID-THERAPY

Disturbances in hemostatic and hemorheological parameters have been in vestigated in a group of 29 children with nephrotic syndrome: 23 child ren classified as steroid-sensitive and 6 as steroid-resistant, Studie s were performed before prednisone treatment and 3 weeks later, after initiation of steroid therapy. Before treatment, the alterations in he mostatic system involved moderate thrombocytosis with spontaneous aggr egation in 19 patients. High levels of fibrinogen, factor VIII, Willeb rand factor, protein C, protein S and alpha(2)-macroglobulin (alpha(2) M) were observed. Factor XII and alpha(1)-antitrypsin (alpha(1)AT) wer e lower than normal. Antithrombin III (ATIII) level was normal in the majority of patients. A plasma and blood hyper-viscosity syndrome was also observed as well as an increase in erythrocyte aggregation. Durin g treatment, an improvement in the hemostatic parameters was observed in the patients who responded to prednisone. The expected increase in factor VIII (frequently described in the literature) was not observed, while there was a significant increase in protein C. In the steroid-r esistant patients, the only significant changes observed were decrease d fibrinogen and increased protein C. The hemorheological parameters s howed a tendency Hemorheology towards normality regardless of whether or not the treatment provided remission Blood viscosity of NS. The rel ationship between hemorheological and hemostatic factors Corticosteroi ds changes are discussed.