Mechanism and treatment of coagulation disorder in membranous nephropathy / 解放军医学杂志

ABSTRACT

Membranous nephropathy (MN) is the most common pathological type of adult nephrotic syndrome (NS), the venous thromboembolism is a common and severe complication making as high as 10% of annual mortality in MN. Prevention of thrombosis is one of the issues needing attention in treatment of MN. The hypercoagulable thrombus in MN is recognized in the field of nephrology, but there are still some controversies about the mechanism of hypercoagulable state caused by coagulation disorder and the anticoagulation treatment scheme. First, it is known that MN hypercoagulable thrombus is related to the state of nephrotic syndrome and its own pathological characteristics, and whether other factors existed is still unclear. Second, it is still controversial whether or not to implement preventive anticoagulation and when to begin anticoagulation in MN patients without thrombus. Plasma albumin is an independent risk factor for thromboembolism in patients with MN, and the risk of thrombosis increases significantly with the decrease of albumin. The guidelines recommend anticoagulant therapy for patients with MN less than 25g/L. There are some shortcomings in the application of anticoagulants recommended in clinical practice and guidelines in MN, and the new application of direct oral anticoagulants (DOAC) in clinical practice in MN lacks effective evidence. How to choose the most suitable anticoagulant is the third problem that nephrologist faces when treating MN. Based on the specific pathological types of MN in NS, the research progress at home and abroad has been reviewed in present paper of the pathogenesis of coagulation disorder in MN, time to initiate preventive anticoagulation and selection of anticoagulant drugs in membranous NS.