Tissue Factor Pathway Inhibitor (TFPI) in Childhood Nephrotic Syndrome

Abstract number: P1949

Abdel Gader A, AL-Mugeirin M, Al-Rasheed S, Al-Salloum A

Background:  It is now recognized that the extrinsic tissue factor pathway is the main trigger to the coagulation system in vivo. Its main inhibitor, tissue factor pathway inhibitor (TFPI), has never been studied in childhood nephrotic syndrome, so far we know.

Aim of the study:  To monitor the level of tissue factor pathway inhibitor (TFPI), in various phases of childhood nephrotic syndrome.

Patients:  139 nephrotic children were classified into the following groups: Group 1, (n = 25): nephrotic patients in relapse receiving no treatment; Group 2 (n = 37): patients in relapse but receiving steroid treatment; Group 3, (n = 45): patients in early remission, and still on steroids; Group 4, (n = 24): patients in established remission receiving no steroids; Group 5 (n = 8): patients who were steroid-resistant. Controls: (n = 84) were healthy age-matched.

Results:

Bound TFPI:  there was significant elevation of bound TFPI levels (X ± SD: 100.8 ± 45.6 ng/ml, 101.2 ± 36.1 ng/ml and 75.6 ± 33.6 ng/ml) in Groups 1 and 2 and 3 respectively; levels were comparable to healthy control levels (60 ± 13.9 ng/ml) in Group 4 (62.9 ± 13.8 ng/ml). The highest levels of bound TFPI (118.6 ± 56.1 ng/ml) were recorded in Group 5.

Free Tissue factor pathway inhibitor (TFPI):  like bound TFPI, the levels of free form of TFPI showed a statistically significant increase, 14.0 ± 6.7 ng/ml, 12.3 ± 4.4 ng/ml, 10.3 ± 3.2 ng/ml and 10.6 ± 6.7 ng/ml Groups 1, 2, 3 and 4, respectively, when compared to levels in healthy control levels (7.6 ± 2.3 ng/ml). The highest levels of free TFPI (22.1 ± 11.3 ng/ml), were recorded Group 5.

Conclusion:  The elevated levels of both the bound and free forms of TFPI in various phases of nephrotic syndrome, adds another natural anticoagulant mechanism, which will offer further protection against thrombo-embolic complications in nephrotic children.