Venous Thromboembolism In Patients With Idiopathic Membranous Nephropathy

Objective:To investigate the predisposing risk factors of venous thromboembolism (VTE) in idiopathic membranous nephropathy(IMN).Methods:We studied89patients with biopsy-proven idiopathic membranous nephropathy from nephrology of Shandong Provincial Hospital from June2008to October2012. According to whether they had suffered from venous thromboembolism, patients were divided into two groups:patients with venous thromboembolism (n=25) and patients without venous thromboembolism (n=64). A retrospective analysis of clinical data of the two groups were performed including age, gender, serum albumin, creatinine, cholesterol, low density lipoprotein, triglyceride, proteinuria, platelet, D-dimer, fibrinogen, etc.Results:1.Out of89patients with IMN,25(28.1%) had at least one VTE.18patients had lower extremity deep venous thrombosis (LDVT),11patients had renal vein thrombosis (RVT),4patients had pulmonary embolism (PE).2.20(80%) cases of thrombosis occurred within6months after the first assessment of proteinuria, while4(16%) cases occurred between6and12months. And only1(4%)case of thrombosis occurred after1year of the first assessment of proteinuria.3.Compared with the control group, the patients with VTE had lower serum albumin (20.5±4.7vs.24.3±5.7g/L, VTE vs. without VTE; P<0.05) and greater24-h proteinuria (8.1±2.8vs.5.6±3.3g/24h, VTE vs. without VTE;P=0.01), and greater fibrinogen (4.3±1.0vs.3.8±0.8g/L, VTE vs. without VTE;P<0.05), lower platelet (225.6±83.8vs.262.5±66.8*109/L, VTE vs. without VTE;P<0.05). The positive rate of D-dimer(84%) was higher in patients with VTE when compared with those without VTE. On multivariate logistic regression, serum albumin (odds ratio,0.8;95%confidence interval, CI:0.7-0.9, p<0.05) and24-h proteinuria (odds ratio,1.2;95%confidence interval, CI:1.1-1.4, p<0.05) were found to be predictors of VTE.Conclusion:1.Thromboembolic complications occur in about28.1%of patients with membranous nephropathy in our study. And LDVT was most common. Most venous thrombosis occurred within one year of first clinical assessment.2. D-dimer above normal level indicates tendency of thrombosis.3.Proteinuria and hypoalbuminemia are risk factors for VTE in patients with IMN.