Hypercoagulability Profile in Patients with Nephrotic Syndrome Before and After Immunosuppressive Therapy at Federal Medical Centre, Abeokuta, South West Nigeria

This study evaluates the evolution of the hypercoagulability profile in nephrotic syndrome patients before and after immunosuppressive therapy at the Federal Medical Centre, Abeokuta, Ogun State, South West Nigeria. Nephrotic syndrome creates a prothrombotic state through urinary loss of natural anticoagulants and elevation of procoagulant factors, yet the dynamic response of coagulation indices to immunosuppressive treatment has not been longitudinally studied in Nigerian patients. A prospective before-and-after analytical study recruited 70 newly diagnosed nephrotic syndrome patients commencing immunosuppressive therapy (predominantly prednisolone with or without cyclophosphamide). Coagulation parameters including fibrinogen, D-dimer, antithrombin III, protein C, protein S, factor V, and VIII were measured at baseline, four weeks, and 12 weeks after treatment initiation. Proteinuria and serum albumin were assessed concurrently. At baseline, fibrinogen was elevated in 88.6 percent, antithrombin III deficiency in 71.4 percent, protein C deficiency in 64.3 percent, and D-dimer elevation in 72.9 percent of patients. At 12 weeks, partial remission was associated with significant improvement in antithrombin III and protein C levels and reductions in fibrinogen and D-dimer. Patients in complete remission showed normalisation of all coagulation parameters. Patients who did not achieve remission maintained or worsened coagulation derangement. The study establishes coagulation profile trajectory as a marker of treatment response and recommends anticoagulation prophylaxis consideration for nephrotic syndrome patients who fail to achieve remission within four weeks. Keywords: nephrotic syndrome, hypercoagulability, antithrombin III, immunosuppressive therapy, Ogun State.