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All Journal KESANS : International Journal of Health and Science
Andira Larasari
Department of Neurology, Faculty of Medicine, Universitas Trisakti, Indonesia
Chemistry Health Professions Medicine & Pharmacology Physics Public Health

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Prolonged Activated Partial Thromboplastin Time in Adults with Nephrotic Syndrome: A Case Report Mutiara Ferina; Alvina Alvina; Karina Shasri Anastasya; Deasyka Yastani; Andira Larasari; Rima Anindita Primandari
Jurnal KESANS : Kesehatan dan Sains Vol 5 No 10 (2026): KESANS: International Journal of Health and Science
Publisher : Rifa'Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.54543/kesans.v5i10.689

Abstract

Introduction: Nephrotic syndrome is classically associated with a hypercoagulable state driven by the compensatory hepatic overproduction of procoagulant proteins and platelet hyperreactivity. However, massive proteinuria can rarely disrupt this paradigm, inducing a paradoxical bleeding diathesis that presents a significant clinical challenge. Discussion: A 22-year-old man presented to the emergency department with a two-week history of generalized edema and a recent onset of melena. Laboratory investigations revealed profound hypoalbuminemia (1.1 g/dL) and extraordinary, massive nephrotic-range proteinuria (63.42 g/24 h), accompanied by dyslipidemia and anemia. Coagulation profiling demonstrated a significantly prolonged activated partial thromboplastin time (aPTT) of 51.4 seconds, confirming an active upper gastrointestinal hemorrhage in the setting of ultra-severe nephrotic. He was treated with methylprednisolone, furosemide, candesartan, and simvastatin, together with albumin transfusion for severe hypoalbuminemia. Conclusion: This case highlights a rare hemorrhagic paradox in nephrotic syndrome and underscores the importance of prompt coagulation workup, including a mixing study, when bleeding occurs in a condition typically considered prothrombotic
Co-Authors Alvina Alvina Deasyka Yastani Karina Shasri Anastasya Mutiara Ferina Rima Anindita Primandari