hypercoagulable state

Introduction

Introduction In patients with a small number of nephrotic syndromes, symptoms of swelling and pain in the lower extremities may occur during the course of the disease. Deep vein thrombosis is detected, which is the cause of swelling and pain in the limbs. Thrombosis is closely related to the hypercoagulable state of nephrotic syndrome.

Cause

Cause

Causes:

There are many reasons why patients with nephrotic syndrome are prone to hypercoagulability, including increased aggregation and procoagulant factors in the blood, and impaired anti-aggregation, anticoagulant and fibrinolysis mechanisms, as well as venous stasis, hyperlipidemia, and low Proteinemia, blood concentration, increased blood viscosity, use of hormones and diuretics. The most direct evidence of hypercoagulable state of nephrotic syndrome is an increase in plasma fibrinogen levels. The catabolic rate of plasma fibrinogen is normal in patients with nephrotic syndrome, and the increase in plasma fibrinogen levels is due to increased synthesis.

In addition, fibrin and fibrinogen degradation products also increased significantly. Plasma fibrinogen and metabolic disorders can disappear with the recovery of nephrotic syndrome. Coagulation factors V, VII, VIII, and X are also elevated, which may be associated with increased liver synthesis. Increased platelet aggregation is also one of the causes of hypercoagulability in nephrotic syndrome, which may be related to hypoproteinemia, hyperlipidemia, and a decrease in the content of capric acid glycoprotein in platelet membranes that prevent platelet aggregation. Abnormal fibrinolytic and anticoagulant systems have decreased levels of plasminogen (although elevated levels of plasminogen activator), elevated levels of a2-macroglobulin, and decreased antithrombin III (loss from urine). Anti-plasmin, antitrypsin a1 plasminogen activator, and endogenous prostacyclin stimulating factor were also reduced.

In the case of nephrotic syndrome, the levels of protein C and protein S are normal or increased, but their activity is reduced, resulting in a hypercoagulable state.

Examine

an examination

Related inspection

Renal CT angiography

Clinical manifestations:

The most common clinical edema, edema of the face, some low back pain, high blood pressure, occasionally found urine protein in the experience of individual patients, when glomerulonephritis may form. If glomerulonephritis is not cured, chronic renal insufficiency may be combined. Because the glomerulus is filtered, if it can not excrete the body waste and toxic gas normally, it will form a multi-visceral and multi-system syndrome in the body, and the diagnosis of renal insufficiency is established. The symptoms are more complicated at this time.

Diagnosis

Differential diagnosis

Identification:

Intravascular coagulation: seen in disseminated intravascular coagulation, also known as DIC, is caused by various causes of small blood vessels coagulation, the formation of a wide range of microthrombus, a large number of coagulation factors are consumed, and secondary activation of fibrinolysis, thus causing serious Extensive systemic bleeding. The disease is also known as: defibrin syndrome, consumptive coagulopathy or intravascular coagulation-defibrinolytic syndrome.

Coagulopathy: refers to one or more abnormal blood coagulation disorders such as congenital or acquired coagulation factor deficiency, vascular wall damage, platelet dysfunction, lack or increase of anticoagulant substances, excessive activation of fibrinolytic system can lead to Coagulopathy.

Coagulation dysfunction: refers to hemorrhagic diseases caused by clotting factor deficiency or dysfunction, which can be divided into two major categories: hereditary and acquired. Hereditary coagulopathy is generally a single clotting factor deficiency, mostly bleeding symptoms in infants and young children, mainly family history; acquired coagulopathy is more common, rehabilitation patients often have multiple clotting factor deficiency, mostly in adulthood Clinically, in addition to bleeding, there are symptoms and signs of primary disease.

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