Disordered Hemostasis and Renal Disorders

Renal disorders can impact the balance of hemostasis and can result in predispositions to either bleeding or thrombosis. This delicate balance is influenced by normal physiologic changes in childhood that need to be taken into consideration when assessing and treating children with kidney diseases. This chapter reviews normal physiologic conditions and changes that occur during childhood. The two spectrums of hemostasis are then described in detail including conditions associated with bleeding (uremic coagulalopathy) and thromboses (nephrotic syndrome, antiphospholipid antibody syndrome, renal vascular thromboses and hemolytic uremic syndrome). Treatment recommendations are provided based on best evidence and standards. Hemostasis, the balance between bleeding and clotting in the body, differs in normal children compared to adults. In children with renal disease, disturbances in the balance of hemostasis can occur resulting in either bleeding or thrombosis. This chapter will describe normal developmental hemostasis in children in addition to hematologic disturbances in those with renal diseases.