Evaluation of baseline plasma protein S functional activity variations as a predictor of thromboembolic recurrence in nephrotic syndrome

International Journal of Hematology | Vol. 9, No. 10, October 2018 | pp. 73–80
DOI: 10.46882/2018/IJH/000106

Original Article

Title: Evaluation of baseline plasma protein S functional activity variations as a predictor of thromboembolic recurrence in nephrotic syndrome

Names of Authors: E. F. Chinedu¹, G. H. Haruna², I. J. Balogun³

Authors’ Affiliations: ¹Department of Haematology, University of Nigeria Teaching Hospital, Enugu, Nigeria; ²Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Nigeria; ³Department of Chemical Pathology, University of Ilorin, Ilorin, Nigeria

Abstract: Massive urinary loss of low-molecular-weight regulatory proteins creates a severe hypercoagulable state in nephrotic disease, yet the clinical utility of functional protein S monitoring remains under-analyzed. This prospective study evaluated baseline plasma free protein S functional activity in 54 adult patients with active nephrotic syndrome to track its correlation with serum albumin depletion and 1-year thromboembolic recurrence outcomes. Protein S activity was quantified using a clotting assay based on factor Xa inhibition prior to initiating corticosteroid regimens. Severe protein S activity reduction (< 50.0%) was identified in 31.4% (17 of 54) of the nephrotic patients. Multivariable Cox proportional hazards analysis revealed that baseline protein S functional activity below 50.0% was an independent predictor of acute deep vein thrombosis or pulmonary embolism within a 12-month follow-up window (hazard ratio = 3.84, P < 0.01). Furthermore, protein S depression correlated inversely with serum albumin levels (r = -0.65, P < 0.001) and positively with D-dimer concentrations. Screening for functional protein S activity provides clear prognostic utility, helping identify high-risk nephrotic patients who may benefit from early prophylactic anticoagulation.

Keywords: Nephrotic syndrome, protein S activity, hypercoagulability, albuminuria, thromboembolism

Manuscript Timeline: Received: July 20, 2018; Revised: August 25, 2018; Accepted: September 12, 2018; Published: October 14, 2018

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