ISSN 2997-1036
International Journal of Hematology | Vol. 15, No. 10, October 2024 | pp. 73–80
DOI: 10.46882/2024/IJH/000176
Original Article
Title: Evaluation of baseline plasma protein C activity as an independent predictor of recurrent macrovascular thrombosis in lupus glomerulonephritis
Names of Authors: E. F. Chinedu¹, G. H. Haruna², I. J. Balogun³
Authors’ Affiliations: ¹Department of Haematology, University of Nigeria Teaching Hospital, Enugu, Nigeria; ²Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Nigeria; ³Department of Chemical Pathology, University of Ilorin, Ilorin, Nigeria
Abstract: Massive renal loss of low-molecular-weight regulatory proteins via porous glomerular structures creates a severe hypercoagulable state in nephrotic-range lupus glomerulonephritis, but the predictive utility of functional protein C tracking remains under-analyzed. This prospective study evaluated baseline plasma free protein S and protein C functional activity in 54 adult patients presenting with active lupus glomerulonephritis to track correlations with serum albumin depletion and 1-year thromboembolic outcomes. Protein C activity was quantified via chromogenic substrate assays prior to initiating intensive immunosuppressive therapies. Severe protein C activity reduction (< 55.0%) was identified in 29.6% (16 of 54) of the nephrotic patients. Multivariable Cox proportional hazards analysis revealed that baseline protein C activity below 55.0% was an independent predictor of acute deep vein thrombosis or pulmonary embolism within a 12-month observation window (hazard ratio = 3.84, P < 0.01). Protein C depression correlated inversely with serum albumin levels (r = -0.65, P < 0.001) and positively with D-dimer concentrations. Screening for functional protein C activity provides clear prognostic utility, helping identify high-risk autoimmune renal populations requiring early prophylactic anticoagulation.
Keywords: Lupus glomerulonephritis, protein C activity, hypercoagulability, albuminuria, thromboembolism
Manuscript Timeline: Received: July 20, 2024; Revised: August 25, 2024; Accepted: September 12, 2024; Published: October 14, 2024