What is the role of anticoagulants in the management of proteinuria?

Updated: Mar 25, 2020
  • Author: Beje Thomas, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Patients with proteinuria tend to be hypercoagulable due to urinary losses of coagulation inhibitors, such as antithrombin III and protein S and C. The risk of thrombosis appears to be highest in patients with membranous glomerulonephritis. Numerous case reports have described renal vein thrombosis (which usually presents as acute onset of gross hematuria and back pain) in patients with membranous glomerulonephritis.

No randomized controlled trials support the use of prophylactic anticoagulation in patients with nephrotic syndrome. However, guidelines published by Kidney Disease–Improving Global Outcomes (KDIGO) in 2012 recommend treatment with warfarin in patients with nephrotic syndrome who have a low serum albumin level (<2.5 g/dL), especially if the patient has other risk factors for thrombosis. [43]


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