Summary
Porosity, viscoelasticity and morphological properties of plasma fibrin from 16 nephrotic
patients and 16 healthy volunteers were compared. Nephrotic patients were characterized
by formation of tight and rigid plasma fibrin gels which resulted in a slower rate
of fibrin lysis studied either under pressure-driven permeation or diffusional transport
of fibrinolytic agents. These latter findings indicated that both abnormal fibrin
network conformation and abnormal fibrin fiber structure were involved in hypofibrinolysis.
Albumin supplementation up to 40 mg/ml partially restored normal fibrin architecture
and increased the rate of fibrinolysis in these patients. Multiparametric analysis
showed that nephrotic patients were mainly characterized by a low plasma albumin level
(R = -0.85), a low albumin to fibrinogen ratio (R = -0.89) and a high resistance to
lysis (R = -0.82). High triglycerides level was the only plasma modification related
to the slower fibrin lysis rate (R = -0.54). High fibrin rigidity (G’) was the only
fibrin parameter simultaneously related to the nephrotic state (R = 0.75) and the
lysis resistance (R = -0.71). After eliminating the effects of age, albumin and fibrinogen
levels, low fibrin porosity (Ks) and low fiber mass-length ratio (μ) were the main
features of the nephrotic state. These findings are discussed in relation to both
the pathophysiology of thrombotic complications in nephrotic syndrome and their pharmacological
prevention.
Key words
Fibrin - hypofibrinolysis - nephrotic syndrome
