Effect of prednisolone on blood coagulation in primary glomerular diseases

Hypercoagulability is considered as one of the exacerbating factors in glomerular diseases. It is important to investigate the effect of glucocorticoids on blood coagulation which may accelerate the coagulation system. To study this problem, we performed several coagulation tests before and after the treatment of prednisolone in 16 patients with primary glomerular diseases (Membranous Nephropathy 7 cases, Mesangial Proliferative Glomerulonephritis 5, Membranoproliferative Glomerulonephritis 2 and Focal Glomerular Sclerosis 2). The results were as follows-The procoagulant activities of blood coagulation factor VIII, IX and XII were significantly elevated, and activated partial thromboplastin time was shortened. This shortening was dependent on the daily dose of prednisolone. The level of von Willebrand factor activity was elevated. The platelet aggregation rate induced by collagen and ristocetin and the release of ATP induced by ADP and collagen were also elevated. On the other hand, antithrombin III was increased, and fibrinogen was decreased. In addition, total cholesterol was elevated, and urinary protein and creatinine clearance remained to be unchanged. The results showed that a hypercoagulable state was induced by the administration of prednisolone in primary glomerular diseases. Therefore, it is suggested that prednisolone may accelerate the intraglomerular coagulation and other thromboembolic processes. It might be necessary to use the anticoagulants and/or antiplatelet agents against these side effects of glucocorticoids.