الفهرس 
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Abstract
Thromboembolism is among the most serious complications of nephrotic syndrome. Thrombotic episodes are seen in 10% of adults and in ~ 5% of children with NS. Although these complications are less common in children, the consequences are more severe. Thromboembolic complications have been attributed to an imbalance between procoagulant/thrombotic, an anticoagulant/antithrombotic factors, thrombocytosis, hemoconcentration, hyperviscosity, relative immobilization, and therapy with corticosteroids and diuretics.
PZ is a vitamin K-dependent glycoprotein which is synthesized by the liver. PZ serves as a cofactor for the inhibition of factor Xa by ZPI in the presence of calcium ions and phospholipids. The potential role of alterations of protein Z levels in the pathogenesis of thrombotic diseases has been evaluated in several studies that have produced conflicting findings.
The aim of this work was to assess levels of PZ as a risk factor for thrombosis in children with nephrotic syndrome.
This study included 45 individuals: 28 males and 17 females, their ages ranged between 2-10 years. The studied individuals were divided into three groups, group I (1st patient group) included 15 patients in active stage of nephrotic syndrome (9 males and 6 females), their ages ranged between 2.5 - 9 years, group II (2nd patient group) included 15 patients in remission stage (10 males, 5 females), their ages ranged between 2 - 10 years and group III (control group) included 15 apparently healthy age and gender matched subjects as controls (9 males, 6 females), their ages
ranged between 2 - 10 years.
All patients were submitted to the followings: History taking,
clinical examination and hematological and biochemical laboratory
investigation. These include: measurement of Total platelet count,
activated partial thromboplastin time (aPTT), and prothrombin time (PT),
creatinine, 24 hour urine collection for protein excretion for estimation of
protein/creatinine ratio, serum cholesterol level, protein Z levels by
ELISA and Antithrombin III level by Radial immunediffusion assay.
The results of this study revealed that:
There were statistically high significant differences regarding
protein Z level and Antithrombin III level between the studied groups.
There was no statistical significant difference between the studied
groups regarding demographic data, anthropometric measurements,
laboratory data that include (prothrombin time, activated partial
thromboplastin time & serum creatinine) between the studied groups.
There was a high statistical significant difference regarding odema
between the studied groups with no difference regarding hypertension.
That there was a high statistical significant differences regarding
platelet count, urine protein/urine creatinine ratio, serum albumin &
serum cholesterol between the studied groups.
There was no significant correlation between PZ in plasma versus
other variables in the active nephrotic cases.
Antithrombin III is statistically highly negative correlated with
aPTT in the active nephrotic cases. Also it shows statistically negative correlation with Protein/ Creatinine ratio. Also it shows no significant
correlation with the other variables.
ROC curve shows that the optimal cutoff point of protein Z for
diagnosis of active nephrotic syndrome was 2.05 with 93% sensitivity,
77% specificity and 82% accuracy with CI (0.84 - 1.00).