An adult case of nephrotic syndrome presenting with pulmonary artery thrombosis: a case report

Abstract

IntroductionPulmonary artery thrombosis is one of the most important complications in patients with nephrotic syndrome. It is well known among nephrologists, however, that this possibly lethal complication very rarely occurs before the diagnosis of nephrotic syndrome.Case presentationA 21-year-old Japanese woman who had no specific medical history consulted a primary care clinic. Although she had been aware of the edema of her lower extremities for 2 weeks, her chief complaints were palpitations and chest pain, which had started the day before. An electrocardiogram and chest radiograph did not reveal any specific abnormalities. Because her etiology was not clear, she was referred to an emergency division in a hospital 2 days later. Although arterial blood gas analysis did not reveal hypoxemia, computed tomography revealed thrombi of the bilateral pulmonary arteries and left iliac vein. At this point, a laboratory examination confirmed the diagnosis of nephrotic syndrome. Subsequently, she was admitted, and anticoagulant therapy was initiated immediately. The next day, oral corticosteroid therapy was initiated, and an inferior vena cava filter was placed internally. Her proteinuria resolved after 3 weeks of treatment. The prompt and complete response to corticosteroid therapy suggested that minimal change disease was the etiology of the nephrotic syndrome and pulmonary artery thrombosis.ConclusionsAn awareness regarding the complication of pulmonary artery thrombosis in nephrotic syndrome is important not only for nephrologists but for all clinicians. Contrast-enhanced computed tomography is crucial to detect pulmonary artery thrombosis.

IgA nephropathy presenting with pulmonary thromboembolism and renal artery infarct

“…However, they were either membranous nephropathy (16) or not biopsied (17). There were no reports of involvement of renal arteries, though reports of pulmonary artery thrombosis were found (17,18). IgA nephropathy is one of the most common forms of glomerulonephritis in the world.…”

Popliteal arterial thrombosis in nephrotic syndrome: a case report

“…[ 3 ] It is associated with potentially significant and serious arterial and venous thromboembolic complications. [ 1 , 2 , 4 ] Venous thromboembolism is thought to be related to the degree of proteinuria and hypoalbuminemia while arterial thromboembolism is related to the presence of traditional risk factors for atherosclerosis. [ 2 ] Thrombosis most frequently occurs in the earlier months of diagnoses though it may happen at any time during the course of NS.…”

“…Nephrotic syndrome is associated with significant and potentially serious thromboembolic complications. [ 1 , 2 ] Arterial thrombotic complications are relatively rare but more serious than venous ones. Thromboembolic complications in nephrotic syndrome are multifactorial.…”

“…Thromboembolic complications in nephrotic syndrome are multifactorial. [ 1 , 2 ] Steroid therapy which is commonly used in treatment of nephrotic syndrome can itself cause hypercoagulability and provoke thrombosis. [ 1 ] Awareness of the condition and assessment of the risk factors are required to allow appropriate prophylactic measures to be taken while taking care of these patients.…”