Evaluation of platelet indices as novel markers for nephrotic syndrome

Öz

Aim: Platelets play an important role in the pathogenesis of nephrotic syndrome, and the aim in this study is to evaluate platelet indices as markers of this disorder. Methods: A total of 39 patients with nephrotic syndrome, who were followed by the pediatric nephrology department in our center from January 2017 to January 2018, were included in the study. The participants were divided into two groups, as those with steroid-sensitive nephrotic syndrome (n= 26) and those with steroid-resistant nephrotic syndrome (n= 13). Laboratory parameters, including neutrophils, lymphocytes, white blood cells, platelet counts, mean platelet volume, platelet distribution width, plateletcrit and platelet large cell ratios were reviewed retrospectively. Similar parameters from a control group comprising 30 age- and sex-matched healthy subjects were also evaluated and compared with the study groups. Results: White blood cells, neutrophil, platelet and plateletcrit values were found to be greater in the nephrotic syndrome patients than in the controls [(10.83 ± 4.98 x103/µl, 8.96 ± 2.30 x103/µl, P= 0.043), (6.96 ± 4.95 x103/ µl, 4.54 ± 2.39 x103/ µl, P=0.010), (379.49 ± 120.87 x103/µl, 328.83 ± 69.42 x103/ µl, P=0.032), (0.38 ± 0.11%, 0.33 ± 0.06%, P=0.012) respectively]. Plateletcrit values were greater in the steroid-resistant nephrotic syndrome group when compared to the control group (0.42 ± 0.14%, 0.33 ± 0.06%) (P= 0.007). Conclusion: Plateletcrit could serve as a marker for steroid-resistant nephrotic syndrome, although further studies involving larger samples should be carried out to determine changes in platelet indices that occur in association with nephrotic syndrome.

Anahtar Kelimeler

• Blood platelets
• nephrotic syndrome
• platelet activation

Nefrotik sendromlu hastalarda trombosit indekslerinin değerlendirilmesi

Öz

Amaç: Trombositlerin nefrotik sendrom patogenezinde önemli rolü vardır. Bu çalışmada trombosit indekslerinin nefrotik sendromda belirteç olarak kullanılması araştırıldı. Yöntem: Ocak 2017-Şubat 2018 tarihleri arasında merkezimizde Çocuk Nefroloji Polikliniği’nde takip edilen 39 hasta çalışmaya dahil edildi. Katılımcılar, steroide duyarlı nefrotik sendrom (n= 26) ve steroide dirençli nefrotik sendrom (n= 13) olarak iki gruba ayrıldı. Hastaların nötrofil, lenfosit, lökosit, trombosit sayıları, ortalama trombosit hacmi, trombosit dağılım genişliği, platelekrit ve trombosit sayıları retrospektif olarak elde edildi. Yaş ve cins olarak uyumlu 30 sağlıklı kontrolden de aynı parametreler elde edildi ve hasta grubuyla karşılaştırıldı. Bulgular: Hasta grubunda kontrol grubuna göre sırasıyla lökosit, nötrofil, trombosit ve platelekrit değerleri daha yüksek saptandı [(10.83 ± 4.98 x103/µl, 8.96 ± 2.30 x103/µl, P= 0.043), (6.96 ± 4.95 x103/ µl, 4.54 ± 2.39 x103/ µl, P=0.010), (379.49 ± 120.87 x103/µl, 328.83 ± 69.42 x103/ µl, P=0.032), (0.38 ± 0.11%, 0.33 ± 0.06%, P=0.012) ]. Steroid direnci açısından değerlendirildiğinde steroide dirençli nefrotik sendrom grubunda platelekrit değeri kontrole göre daha yüksek bulundu (%0.42 ± 0.14, %0.33 ± 0.06) (P= 0.007). Sonuç: Platelekrit, steroide dirençli nefrotik sendromda steroid direncini gösteren bir belirteç olarak kullanılabilir. Bu bulguyu desteklemek için daha geniş hasta grubuyla çalışmalar yapılmalıdır.

Anahtar Kelimeler

• Trombositler
• trombosit aktivasyonu
• nefrotik sendrom

Kaynakça

1. 1. Bauvois B ve ark. Specific changes in plasma concentrations of matrix metalloproteinase-2 and -9, TIMP-1 and TGF-beta 1 in patients with distinct types of primary glomerulonephritis. Nephrol Dial Transplant. 2007;22(4):1115–1122.
2. 2. Dame C ve Sutor AH. Primary and secondary thrombocytosis in childhood. Br J Haematol.2005;129:165–77.
3. 3. Walter E ve ark. Platelet hyperaggregability as a consequence of the nephrotic syndrome. Thromb Res.1981;23:473–9.
4. 4. Kocyiğit I ve ark. The role of platelet activation in determining response to therapy in patients with primary nephrotic syndrome. Platelets 2012;24:474-479.
5. 5. Shah B, ve ark. Mean platelet volume and long-term mortality in patients undergoing percutaneous coronary intervention. Am J Cardiol 2013;111:185-189.
6. 6. Bain BJ ve Bates I. Basic haematological techniques. In: Lewis SM, Bain BJ, Bates I (eds). Dacie and Lewis Practical Haematology, 9thed. Edinburgh: Churchill Livingstone;2001:19-46.
7. 7. Giovanetti TV ve ark. Platelet indices: laboratory and clinical applications. Rev Bras Hematol Hemoter. 2011; 33(2): 164-165.
8. 8. Ozturk ZA ve ark. Could platelet indices be new biomarkers for inflammatory bowel diseases? Eur Rev Med Pharmacol Sci 2013;17:334-41.

9. 9. Kim DA ve Kim TY. Controversies over the interpretation of changes of mean platelet volume in rheumatoid arthritis. Platelets 2011;22:79-80. http://dx.doi. org/10.3109/09537101003663758.
10. 10. Kisacik B ve ark. Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis. Joint Bone Spine 2008;75:291-4. http://dx.doi. org/10.1016/j.jbspin.2007.06.016.
11. 11. Takeyama H ve ark. Platelet activation markers are associated with Crohn’s disease activity in patients with low Creactive protein. Dig Dis Sci 2015;60:3418-23. http://dx.doi. org/10.1007/s10620-015-3745-2.
12. 12. Budak YÜ ve ark. The use of platelet indices, platelecrit, mean platelet volume and platelet distribution width in emergency non-traumatic abdominal surgery: a systematic review. Biochemia Medica 2016; 26(2):178-93.
13. 13. Grotto HZW ve Noronha JFA. Platelet larger cell ratio (P-LCR) in patientes with dyslipidemi. Clin. Lab. Haem. 2004; 26: 347-349.
14. 14. Machleidt C ve ark. Multifactorial genesis of enhanced platelet aggregability in patients with nephrotic syndrome. Kidney Int. 1989;36:1119–1124.
15. 15. Gawaz M ve ark. Platelets in inflammation and atherogenesis. J Clin Invest 2005; 115:3378–3384.
16. 16. Sowa JM ve ark. Platelet influence on T- and B-cell responses. Arch Immunol Ther Exp (Warsz) 2009; 57: 235–241 71.
17. 17. Peerschke EI ve ark. Platelet mediated complement activation. Adv Exp Med Biol 2008; 632:81–91.
18. 18. Zdrojewski Z ve ark. Influence of spontaneous platelet aggregation on progression of glomerular disease. Nephron 2002;92:36-42.
19. 19. Coskun ME ve ark. Plateletcrit: A Possible Biomarker of Inflammation in Hepatitis A Infection. Niger J Clin Pract 2019; 22: 727-30.
20. 20. Yuksel O ve ark. An overlooked indicator of disease activity in ulcerative colitis: Mean platelet volume. Platelets 2009;20:277-81.
21. 21. Ergelen M ve Uyarel H. Plateletcrit: A novel prognostic marker for acute coronary syndrome. Int J Cardiol 2014;177:161.
22. 22. Ozturk ZA ve ark. Could platelet indices be new biomarkers for inflammatory bowel diseases? Eur Rev Med Pharmacol Sci 2013;17:334-41. 23. Tang J ve ark. Plateletcrit: A sensitive biomarker for evaluating disease activity in Crohn's disease with low hs-CRP. J Dig Dis 2015;16:118-24.
23. 24. Sahin F ve ark. Prominent features of platelet count, plateletcrit, mean platelet volume and platelet distribution width in pulmonary tuberculosis. Multidisciplinary respiratory medicine. 2012; 7(1): 38.
24. 25. Yilmaz Z ve ark. Evaluation of platelet count and its association with plateletcrit, mean platelet volume, and platelet size distribution width in a canine model of endotoxemia. Veterinary clinical pathology. 2008; 37(2): 159-63.
25. 26. Tuzun A ve ark. The predictive value of mean platelet volume, plateletcrit and red cell distribution width in the differentiation of autoimmune gastritis patients with and without type I gastric carcinoid tumors. Platelets. 2014; 25(5): 363-6.
26. 27. Gul M ve ark. Long-term prognostic significance of admission plateletcrit values in patients with non-ST elevation myocardial infarction. Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis. 2016; 27(6): 696-701.
27. 28. Vakili M ve ark. Changes of platelet indices in juvenile idiopathic arthritis in acute phase and after two months treatment. Iran J Pediatr 2016;26:e5006. 29. Göknar N ve ark. The Importance of Mean Platelet Volume in Children with Nephrotic Syndrome. Dicle Medical Journal. 216; 43(2):275-278.
28. 30. Gilman Goodman A ve ark. Adrenocortical steroids. The Pharmacological basis of theurapeutics 9th ed. 1998; 59:1465-85.