1
The clinical significance of platelet count among pediatric patients with Nephrotic Syndrome
ABSTRACT
Objectives : To determine the relationship of initial platelet count between pediatric patients with steroid
responsive and steroid non responsive nephrotic syndrome admitted January 1997- May 2014 at UMC
Patients : Patients with Idiopathic Nephrotic Syndrome aged 1-18 years old
Methods : Demographic, hematologic, serologic and urinalysis findings were analyzed. Patient were
grouped into, group A (steroid non responsive) and group B (steroid responsive). Comparison of initial
platelet count between group A and group B were analyzed.
Results : A total of 90 pediatric patients with Idiopathic Nephrotic Syndrome were included in the study.
Most of the patients belong to the 1-5 years old age. Fifty-seven (63.3%) were males while there were 33
(36.7%) females with a 1.7 : 1 male to female ratio. Most patients consulted because of edema. Anemia
(53.2%) and leukocytosis (75.6%) were noted. Low albumin and hypercholesterolemia were consistent
with nephrotic syndrome. Majority of the patients (63.3%) showed urine albumin levels or a with
nephrotic range proteinuria. All variable were analyzed between group A and group B showed no
statistically significant difference. Platelet count is only 1 variable significant with Fishers exact p-value
of 0.005812.
Conclusion : Patient with increased platelet count had 1.3 times more likely to be steroid non responsive
than those normal platelet count.
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I. INTRODUCTION
A. Burden of Illness
Hyperlipidemia, hypercholesterolemia, and increased lipiduria are usually associated. Although not
commonly thought of as part of the syndrome, hypertension, hematuria, and azotemia may also
occur1. The annual incidence of NS in children in the USA and in Europe has been estimated to be 1
7 per 100,000 children, with a cumulative prevalence of 16 per 100,000 children2. There is
epidemiological evidence of a higher incidence of nephrotic syndrome in children from south Asia. In
the Philippines, nephrotic syndrome accounts for 10.2 cases per 100, 000 population and based on the
secondary, congenital or infantile. . Idiopathic nephrotic syndrome (INS) is the most frequent form of
NS in children representing more than 90 percent of cases between 1 and 10 years of age and 50
percent after 10 years of age2. Secondary nephrotic syndrome is defined as nephrotic syndrome
associated with well-defined diseases that are inflammatory (e.g., lupus nephritis, acute postinfectious
are occur before the age of one year and are mostly associated with infections (e.g., syphilis,
toxoplasmosis, etc.) or with mutations of genes coding for podocytes proteins and are steroid resistant
The most common form of NS in children is minimal change lesion (MCL). The vast
majority of patients with MCL (>90%) respond to steroid therapy. Other types of INS like focal and
More than 90 percent of patients who respond to steroid therapy have MCL. MCL can accurately be
3
diagnosed based on presenting clinical findings in children younger than 6 years of age, absence of
hypertension, absence of hematuria, normal complement levels, and normal renal function4.
The risk factors of thrombosis are increased thrombocyte aggregation, increased coagulation factors,
9
hypovolemia, corticosteroid treatment, and increased platelet count (thrombocytosis) .
Thrombocytosis occurs in 57.5% of NS patients. Most children with idiopathic NS respond to initial
steroid treatment; however approximately 60-80% of cases will undergo relapse and half of them
have frequent relapses or steroid dependence, needing high dose steroid administration to achive
remission. During the relapse episode, NS patients tend to have increased platelet count compared to
that in the initial attack. Frequent relapse nephrotic syndrome (FRNS) patients may need long term
steroid therapy, i.e., 6-12 months, which may increase the risk of thrombocytosis8.
B. Disease Causation
The glomerular capillary wall consist of three structural elements that constitute the
permselectivity barrier : endothelial cells separated by fenestrae, the glomerular basement membrane
made up of a network of matrix proteins, and specialised epithelial cells (podocytes) connected to
each other via an interdigitating network of slit diaphragms. Normally, proteins the size of albumin
(69 kd) and larger are excluded from filtration, a restriction that depends substantially on the integrity
of the slit diaphragms. In nephrotic syndrome, glomeruli appear greatly changed adjacent podocytes
system, especially T-cell mediated immunity. Steroid-resistant nephrotic syndrome can be associated
with mutations in NPHS2 (podocin) and WT1 genes, as well as other components of the glomerular
filtration apparatus, such as the slit pore, and include nephrin, NEPH1, and CD2 associated protein6.
4
Although, the mechanism of edema formation in nephrotic syndrome is incompletely
understood, it seems likely that in most instances, massive urinary protein loss leads to
hypoalbuminemia, which causes a decrease in plasma oncotic pressure and transudation of fluid from
the intravascular compartment to the interstitial space. In the nephrotic state, serum lipid levels
hepatic protein synthesis, including synthesis of lipoproteins. This is also why a number coagulation
factors are increased, increasing the risk of thrombosis. In addition, lipid catabolism is diminished as
a result of reduced plasma levels of lipoprotein lipase related to increased urinary losses of this
enzyme. Nephrotic syndrome is a hypercoagulable state resulting from multiple factors : vascular
statis, an increase in hepatic production of fibrinogen and other clotting factors, decreased serum
levels of anticoagulation factors, increased platelet production (as an acute phase reactant), and
albumin <2.5g/dL), hyperlipidemia (serum cholesterol >200 mg/dL) and edema. Nephrotic range
proteinuria is present if early morning urine protein is +3 or +4 (on dipstick test), spot
protein/creatinine ratio >2mg/mg, or urine albumin excretion >40mg/m2 per hour. Based on a study
done by Maravillosa, et al in our insitution on patients with idiopathic nephrotic syndrome diagnosed
with the aid of routine urinalysis,urine protein level of +2 to +4 has a high specificity of 91.67% with
Adequate treatment of the initial episode, both in terms of dose and duration of
corticosteroids is important. The standard medication for treatment is prednisolone or prednisone. The
recommended. Prednisone is initially given at a dose of 60mg/m2/day in a single dose for 4-6 weeks.
According to the statistics, 80-90% of children respond to steroid therapy within 3 weeks. Signs of
positive response to steroid therapy include diuresis, disappearance of edema and urine finding of
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trace or negative protein. After the 4-6 week daily course, steroids are tapered to 40mg/m2/day given
every other day for 4 weeks(maintenance phase). After the four week maintenance phase, the steroid
is slowly tapered for 1-2 months until the patient is off the medications6.
Children who continue to have proteinuria (+2 or greater) after 8 week of steroid therapy
are considered steroid resistant, and diagnostic renal biopsy should be performed. A subset of patients
relaps while on alternate day steroid therapy or within 28 days of completing a successful course of
prednisone therapy. Such patients are termed steroid dependent. Patients who respond well to
prednisone therapy but relapse 4 times in a 12 mo period are termed frequent relapses6.
with nephrotic syndrome and are considered a major threat to nephrotic patients. Numerous factor are
coagulation factor and inhibitor as well as decreased fibrinolytic activity. In addition, thrombocytosis
and platelet hyperactivity have been suggested to contribute to the thrombophilic diathesis
characteristic of NS.
among pediatric patients with nephrotic syndrome, both in relapse and in remission than in the
controls, with statistically highly significants differences (p<0.001), but there was no difference in
platelet count between the proteinuria and remission group (p>0.05). This supports the hypothesis
that platelets may play significant role in generating hypercoagulability in NS. The above findings
have informed the present policy of using antiplatelet drugs and low molecular weight heparin in
patient with NS. The indications for anticoagulants include significant thrombocytosis, resistant
oedema, severe ascites with dilated veins around the umbilicus, renal biopsy findings of fibrin
deposition inside the glomeruli and in between the tubules, and glomerulosclerosis.
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In a study conducted in Iran by Mortazavi, et al (2008), thrombocytosis was found in
50% of patients with nephrotic syndrome at relapse period. There was no correlation between urinary
Another study conducted by Hafni, et al (2007) in Bandung, Indonesia , it was found that
the platelet level of frequent relapses of NS (FRNS)patients ( 517909.09) was higher than that of
children with FRNS was higher than that of children with IFRNS.
children aged 2-12 years in the proteinuric phase of idiopathic NS. The study cases included two
groups : Group I : 8 patients in the initial attack of NS and group II: 12 patients in relapse (defined as
recurrence of edema, proteinuria, and hypoalbuminemia). At the time of study, all relapsers were off
steroid therapy for at least one month. Ten healthy children (7 males and 3 females of matching age
and sex served as a control group). Statistical analysis was done using conventional methods. The test
was considered significant if P 0.05. It was found that platelet count was higher in nephrotics
(platelet count range 260.000-750.000) than controls ( platelet count range 170.000-360.000);
relapsers had higher counts (platelet count range 280.000-750.0000) than nephrotics in initial attack
(platelet count range 260.000-400.000) and the differences were statistically significant (P< 0.005 and
P< 0.005 respectively). Mean difference was higher in nephrotic (389.500) than controls (256.000)
and relapsers had higher mean difference (445.833) than initial attack (305.000).
D. Definition of Terms 6
2. Nephrotic syndrome remission : urine albumin nil or trace (or proteinuria <4mg/m2/h) for
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3. Steroid responsive : remission achieved after complete steroid therapy (induction therapy
with prednisone 60mg/m2/day for 6 weeks and tapered course 40mg/m2/day every other day
4. Steroid non responsive include steroid resistant, frequent relapse and steroid dependent.
60mg/m2/day
prednisone therapy
5. Platelet count : a test to measure how many platelets in blood. Platelets are parts of the blood
that help the blood clot. The normal number of platelets in the blood is 150.000-
400.000/mm3
NS. Increased plasma level of coagulation factors, decreased level of natural anticoagulant proteins,
and decreased fibrinolytic activity are reported in nephrosis. The role of platelets in promoting
formation and coagulation at injured vessels wall have been proposed as important mechanism in the
development of thrombosis. It has been postulated that platelet hyperactivity is also an important
Studies have shown that increase platelet count is more commonly found in frequent
relapsing nephrotic syndrome, which puts them at risk for thrombosis. Therefore we should take more
precaution to the occurrence of thrombosis in patient with frequent relapsing nephrotic syndrome.
Thus, this study will attempt to the determine between platelet count of children with nephrotic
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II. OBJECTIVES
General Objective
To determine the relationship of initial platelet count between pediatric patients with steroid
Specific Objectives
5. To compare the initial platelet count of pediatric patients with nephrotic syndrome in relation
A. Study Design
This is a case control study
B. Study setting
De La Salle University Medical Center, a tertiary hospital in the city of Dasmarinas, Province
of Cavite.
responsiveness nephrotic syndrome) equal 416272.73 (SD 14576.35) and mean platelet count
for group B (steroid non responsiveness nephrotic syndrome) equal 517909.09 (SD
165670.30). The study need 45 patients each group to have 95% confidence level and 80%
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D. Study Population
Inclusion criteria :
Pediatric patients 1 to 18 years old with newly diagnosed Idiopathic Nephrotic Syndrome
and completed prednisone therapy with follow up from the year January 1997-May 2014.
1. urinalysis (protein)
3. serum cholesterol
Exclusion criteria :
Those lost to follow up will not be included in this study
Patient with incomplete data
Salle University Medical Center from January 1997- May 2014 were retrieved. Using an
extraction form the following data was retrieved, tabulated and analyzed.
2. Chief complaint
5. Serology test (Total protein, serum albumin, serum globulin and serum cholesterol)
6. Urinalysis (albumin)
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F. Statistical Analysis
Frequency distribution table used to describe demographic and clinical characteristics
of the patients. The study use chi square test to determine if difference in proportion with
increased platelet count between steroid responsive and non responsive patients. The Chi
square statistic is significant at the 0.05 level (p-value 0.05). The 95% confidence interval of
the difference also be computed. Fishers exact test was used for variables where Chi-square
could not be used. Since the reflected values are only those observed, expected cell will be
small if observed values or frequency in some variables of this 2x2 table is small.
G. Ethical consideration
A letter of informed consent of the study were given to the Medical Records of the
hospital. The study was submitted and approved by the Ethics Committee of the hospital prior
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IV. RESULTS
A total of 90 pediatric patients with newly diagnosed Idiopathic Nephrotic Syndrome were
included in the study. Forty-five patients belong to group A (steroid non responsive) and 45 patients
A. Demographic Characteristics
Overall, most of the patients belong to the 1-5 years old age group followed by the 6-10 years old
age group with 59 (65.6%) and 18 (20.0%) patients, respectively. Among the 45 patients who belong to
group A (steroid non responsive) , 29 (64.4%) were 1-5 years old while group B (steroid non responsive)
Fifty-seven (63.3%) were males while there were 33 (36.7%) females with a 1.7 : 1 male to
female ratio. Steroid non responsive patient had 28 (62.2%) males and 17 (37.8%) females with male :
female ratio of 1.6 : 1 while the steroid responsive group had 29 (64.4%) males and 16 (35.6%) females
with male : female ratio of 1.8 : 1. Chi square test done showed no statistically significant difference
Nephrotic Syndrome
Demographic Steroid non Steroid
Total
characteristics responsive responsive
n % n % n % X2 Chi p value
Age
1-5 years old 29 64.4 30 66.7 59 65.6 3.239 0.3562
6-10 years old 11 24.5 7 15.6 18 20.0
11-15 years old 4 8.9 8 17.7 12 13.3
16-18 years old 1 2.2 0 0 1 1.1
Total 45 100 45 100 90 100
Sex
Male 28 62.2 29 64.4 57 63.3 0.04785 0.8269
Female 17 37.8 16 35.6 33 36.7
Total 45 100 45 100 90 100
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B. Clinical Presentation
Table 2 shows the chief complaint of the patients included in the study. Seventy-three
(81.1%) consulted because of edema. Thirty-four (75.5%) out of the 45 patients with steroid non
responsive came with chief complaint edema. No statistical different were noted between the 2
groups.
Nephrotic Syndrome
Steroid non Steroid
Chief complaint Total
responsive responsive
n % n % n % X2 chi p value
Edema 34 75.5 39 86.7 73 81.1 4.085 0.1297
(generalized, periorbital,
facial, scrotal, bipedal)
Table 3 shows most of the patients had fever (n = 38 ) as a symptoms followed by cough,
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Table 3. Signs and symptoms
Nephrotic Syndrome
Steroid non Steroid
Signs and symptoms* Total
responsive responsive
n % n % n % X2 chi p value
Fever
Positive 19 42.2 19 42.2 38 42.2 0 1
Negative 26 57.8 26 57.8 52 57.8
Total 45 100 45 100 90 100
Cough
Positive 10 22.2 12 26.7 22 24.4 0.2406 0.6237
Negative 35 77.8 33 73.3 68 75.6
Total 45 100 45 100 90 100
Abdominal pain
Positive 5 11.1 7 15.6 12 13.3 0.3846 0.5351
Negative 40 88.9 38 84.4 78 86.7
Total 45 100 45 100 90 100
Tea colored urine
Positive 7 15.6 5 11.1 12 13.3 0.3846 0.5351
Negative 38 84.4 40 88.9 78 86.7
Total 45 100 45 100 90 100
Vomiting
Positive 5 11.1 5 11.1 10 11.1 0 1
Negative 40 88.9 40 88.9 80 88.9
Total 45 100 45 100 90 100
Dyspnea
Positive 5 11.1 4 8.9 9 10 0.1235 0.7253
Negative 40 88.9 41 91.1 81 90
Total 45 100 45 100 90 100
*Note : One patient can have more than one sign/symptom enlisted
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C. Hematologic test
Table 4. shows the initial complete blood count results. Forty-seven out of the 90 (52.2%)
patients showed below the normal hemoglobin on their complete blood count . Forty (44.4%)
patients had below the normal hematocrit levels. Sixty-eight (75.6%) patients showed leukocytosis on
their complete blood count. Forty-six (51.1%) patients with Idiopathic nephrotic syndrome showed
thrombocytosis, 30 (66.7%) were steroid non responsive while 16 (35.6%) were steroid responsive.
On the other hand, majority of the patients with normal platelet count belong to the steroid responsive
group with 29 (64.4%) compared with 15 (33.3%) in the steroid non responsive group. Fisher exact
test showed with p-value of 0.005812 which mean that the difference of the platelet count between
Nephrotic Syndrome
Complete Blood Steroid non Steroid
Total
Count responsive responsive
n % n % n % X2 chi p value
Hemoglobin
Decreased 18 40.0 29 64.4 47 52.2 Fishers
Increased 17 37.8 11 24.5 28 31.1 0.0653
Normal 10 22.2 5 11.1 15 16.7
Total 45 100 45 100 90 100
Hematocrit
Decreased 17 37.8 23 51.1 40 44.4 1.914 0.3841
Increased 17 37.8 15 33.3 32 35.6
Normal 11 24.4 7 15.6 18 20.0
Total 45 100 45 100 90 100
White Blood
Count 0 1
Increased 34 75.6 34 75.6 68 75.6
Normal 11 24.4 11 24.4 22 24.4
Total 45 100 45 100 90 100
Platelet count
Increased 30 66.7 16 35.6 46 51.1 Fishers
Normal 15 33.3 29 64.4 44 48.9 0.005812
Total 45 100 45 100 90 100
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Table 5. shows that 85 (94.4%) patients have decreased level of total blood protein.
Eighty-eight (97.8%) patients showed decreased serum albumin levels, and 2 out of the 90 patients
showed normal levels of serum albumin despite having nephrotic syndrome. Forty-eight (53.3%)
patients showed normal serum globulin. Eighty-six (95.6%) patients had a decreased serum albumin
to globulin ratio. Seventy-eight (86.7%) patients showed increased serum cholesterol level. There are
no statistical significant difference between the two group.
Nephrotic Syndrome
Steroid non Steroid
Serologic Test Total
responsive responsive
n % n % n % X2 chi pvalue
Total Protein
Decreased 44 97.8 41 91.1 85 94.4 1.906 0.1676
Normal 1 2.2 4 8.9 5 5.6
Total 45 100 45 100 90 100
Serum Albumin
Decreased 44 97.8 44 97.8 88 97.8 0 1
Normal 1 2.2 1 2.2 2 2.2
Total 45 100 45 100 90 100
Serum Globulin
Normal 23 51.1 25 55.6 48 53.3 1.303 0.5213
Decreased 22 48.9 19 42.2 41 45.6
Increased 0 0 1 2.2 1 1.1
Total 45 100 45 100 90 100
Albumin/Globulin
ratio 43 95.6 43 95.6 86 95.6 0 1
Decreased 2 4.4 2 4.4 4 4.4
Normal 45 100 45 100 9 100
Total
Serum Cholesterol
Increased 40 88.9 38 84.4 78 86.7 0.3846 0.5351
Normal 5 11.1 7 15.6 12 13.3
Total 45 100 45 100 90 100
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D. Urinalysis
Table 6. shows the urine albumin level, majority of the patients (n=57) have +4 to +3 while
33 (36.7%) out of the 90 study population were noted to have trace to +2 urine albumin levels.
Nephrotic Syndrome
Steroid non Steroid
Urine Protein Total
responsive responsive
n % n % n % X2 chi p value
Albumin
+4 to +3 27 60.0 30 66.7 57 63.3 0.4306 0.5117
(trace to +2) 18 40.0 15 33.3 33 36.7
Table 7 shows that those who increased platelet count has increased risk of steroid non
responsive. Patient with increased platelet count had 1.3 times more likely to be steroid non
Table 7. Comparison of platelet count between steroid non responsive and steroid
responsive nephrotic syndrome.
Nephrotic Syndrome
Steroid non Steroid
Total
Platelet Count responsive responsive
95% CI
n % n % n % OR p-value
of OR
Increased 30 66.7 16 35.6 46 51.1 1.373 1.147, Fishers
Normal 15 33.3 29 64.4 44 48.9 6.533 0.005812
Total 45 100 45 100 90 100
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V. DISCUSSION
Nephrotic syndrome (NS) is one of the most frequent glomerular diseases seen in
children with the potential of progression to end stage renal disease. The mortality rate of NS was
40% before 1940, primarily due to infection, but this has been significantly reduced with the
introduction of steroid treatment and antibiotics. Steroids have long been used as the first line of
treatment in NS, however other immunesuppressives may be indicated when prednisolone fails to
Every physician should be keen in taking a complete history and performing a thorough
physical examination before starting treatment with corticosteroid. The height, weight, and blood
pressure should be recorded. Regular weight record helps to monitor decrease or increase of edema.
Physical examination is done to detect infections and underlying systemic disorder (e.g systemic
lupus erythematous, Henoch schonlein purpura). Infection should be treated before starting therapy
with corticosteroids. Investigations recommended at the initial episode include urinalysis, complete
blood count, blood levels of albumin, cholesterol, urea and creatinine. Estimation of blood levels of
antistreptolysin O and C3 is required in patients with gross or microscopic hematuria. Urine culture is
not necessary unless the patient has clinical features suggestive of urinary tract infection.
Adequate treatment of the initial episode, both in terms of dose and duration of
corticosteroids, is important. Evidence from multiple studies suggest that appropriate therapy at the
first episode of nephrotic syndrome is an important determinant of the long term course of disease.
About 80% children with idiopathic nephrotic syndrome show remission of proteinuria
following treatment with corticosteroids (steroid responsive). Most patients have multiple relapses,
placing them at risk for steroid toxicity, systemic infections, and other complications. A small
proportion of patients who are steroid resistance are also risk for similar complications and renal
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insufficiency. Focal segmental glomerulosclerosis (FSGS) is the main cause of steroid resistant NS
and accounts for 10-20% of end stage renal disease (ESRD) in children.12
This study aimed to compare initial platelet count of pediatric patients with nephrotic
syndrome and evaluate if it can be used as a biomarker for steroid responsiveness or steroid non
responsiveness.
Ninety children with INS were analyzed. There were slightly more male (63.3%) than
female (36.7%), with a 1.7 : 1 male : female ratio and within the age range of 1-5 years old. A number
of studies show Idiopathic NS is the most frequent form of NS in children representing more than 90
percent of cases between 1 and 10 years of age and show a male preponderance.
Sahana.10 Thirty-four patients with steroid non responsive and 39 patients with steroid responsive had
edema. This have a p-value of 0.1297, which shows that the difference is statistically not significant.
Most of the patients had fever as a symptom followed by cough, abdominal pain, tea colored urine,
The hematologic and serologic findings characteristic were described. The complete
blood count of the study population showed that the difference is statistically not significant. In a
study done by Sahana, 74% of patients had anemia. In nephrotic syndrome, many nonalbumin
proteins are excreted in the urine, including transferrin and erythropoietin (EPO). Urinary losses of
EPO can cause EPO-deficiency anemia and prevent the normal increase in plasma EPO level in
response to anemia and hypoxia in NS. Similarly, tranferrinuria and increased transferrin catabolism
Sixty-eight out of 90 patients have leukocytosis, which is can be explained why patients
with nephrotic syndrome are prone to infections. Thirty-four patients of each group had leukocytosis.
The most common forms of infection in nephrotic syndrome are cellulitis, peritonitis and sepsis.
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Patients with nephrotic syndrome are known to have functional abnormalities in their immune
system. These abnormalities include low serum IgG due to urinary losses of IgG, altered T-cell
Most of the patients showed thrombocytosis, 30 patients under group steroid non
responsive and 16 patients under group steroid responsive showed p-value of 0.005812. It shows that
the difference is statistically significant, which means that increased platelet count more likely to be
steroid non responsive than those normal platelet count. According to a study by Gulleroglu et al.,
mean platelet count in the steroid resistant group was significantly higher than steroid sensitive group.
It is can be explained why patients with nephrotic syndrome are prone to develop thrombosis
volume depletion (which can worsen with aggressive diuresis). The majority of studies on platetet in
NS revealed hyper-aggregation tendency to various aggregating agents in both nephrotic adults and
a higherconcentration of free arachidonic acid that is normally bound to albumin. 13 Yashida and Aoki
found that enhanced platelet aggregation in NS was normalized in vitro by the addition of albumin to
patientss platelet rich plasma and in vivo by the correction of hypoalbuminemia by treatment. Shattil
et al. demonstrated that the acquisition of cholesterol by platelets in vitro is associated with increased
platelet sensitivity to aggregating agents. Other study done by El domiaty et al., revealed that a
significant correlation between ADP induced platelet hyperaggregability and the degree of
statistically significant difference was also noted. The reason why many patients had low albumin
levels can be explained by the fact that abnormality in nephrotic syndrome is an increased
20
permeability of the glomerular capillary wall, which leads to massive proteinuria and
The urinalysis results of the study population showed the urine albumin levels, majority
of the patients have +3 urine albumin levels, while 35(38.9%) of these patients showed urine albumin
level of trace to +2. Based on study by Maravillosa in 2012 revealed that the level of protein on
routine urinalysis is not accurate in measuring nephrotic range proteinuria, that is, the degree of
proteinuria based on dipstick is not directly related to the quantitative value of urine protein. Thus, 24
hour urine protein also recommended, which still remains the gold standard of diagnostic
examination. The mechanism of proteinuria is due to glomerular structural changes with greater
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VI. CONCLUSION
Ninety patients with newly diagnosed nephrotic syndrome were included in the study to
compare initial platelet count between steroid responsive and steroid non responsive.
This study showed that most of the patients nephrotic syndrome belong to the 1-5 years
old age. There is noted male preponderance with a male : female ratio of 1.7 : 1. There are no
statistically significant difference between the 2 groups according to age and sex. Edema was the
On the initial complete blood count showed that both groups had anemia and
leukocytosis. However, thrombocytosis was higher in group steroid non responsive than steroid
responsive.
With regards to other serologic tests such as TPAG, serum cholesterol, no statistically
significant difference was also noted. The urinalysis results of the study population showed the urine
albumin levels, majority of the patients have +4 to +3 urine albumin levels. Quantitatively, all
Nephrotic patient with increased platelet count are 1.3 times more likely to be steroid non
responsive than those with normal platelet count. Thus, pediatric nephrotic syndrome patient with
increased platelet count should be monitored closely so as to identify whether there patient are
actually non minimal change NS patient which necessitated renal biopsy for histologic diagnosis and
prognosticative.
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VII. RECOMMENDATION
This study is limited since it was done retrospectively. It is recommended that a larger
sample size be used in order to further validate the data provided in this study. Other parameters such
as prothrombin time (PT), partial thromboplastin time (PTT), and mean platelet volume are also
recommended as to further assess the hypercoagulable state in patients with nephrotic syndrome.
23
REFERENCES
1. Safaei, et al. Spectrum of childhood Nephrotic Syndrome in Iran : A single center study.
Indian Journal Nephrology.Vol 19. Number 3. Page 87-90. July 2009
3. Cabrera, B. A Correlation analysis of urine protein dipstick levels and serum albumin in
children with Nephrotic Syndrome: A Case Control Study. Book of Abstracts. Philippine
Pediatric Society 2002-2005. 165-166
5. Eddy,et al. Nephrotic Syndrome in childhood. The Lancet. Vol 362. Page 629-639. August
2003
9. Haycock, G. The child with nephrotic syndrome. Clinical Paediatric Nephrology, Oxford
New York . 3rd edition, 2003. Page 341-366.
10. Sahana, KS. Clinical profile of Nephrotic Syndrome. Journal of Evolution of medical and
dental science. 2014. Vol 3. Issue 4. January 27. P863-870
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12. Mortazavi et al. Steroid responsive pattern and outcome of pediatric nephrotic syndrome : a
single-center experience in Nortwest Iran. Department of Pediatric Nephrology, Tabriz
University of Medical Sciences, Tabriz, Iran. May 2011. p167-171.
14. Gulleroglu K et al. Clinical importance of mean platelet volume in children with nephrotic
syndrome. Ren Fail. Feb 2014.
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APPENDIX A- EXTRACTION FORMS
Name :
Chief complaint :
Signs/ Symptoms :
Albumin +4 / +3 / +2 / +1 / trace
WBC
RBC
Hemoglobin
Hematocrite
WBC
Platelet count
26
After complete prednisone therapy :
Remission - urine albumin nil or trace (or proteinuria <4mg/m2/h) for three consecutive
early morning specimens
no (steroid resistant)
27
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