Bilateral iliac and popliteal arterial thrombosis in a child with focal segmental glomerulosclerosis

Abstract

Thromboembolic complications (TECs) are clinically important sequelae of nephrotic syndrome (NS). The incidence of TECs in children is approximately 2%–5%. The veins are the most commonly affected sites, particularly the deep veins in the legs, the inferior vena cava, the superior vena cava, and the renal veins. Arterial thrombosis, which is less common, typically occurs in the cerebral, pulmonary, and femoral arteries, and is associated with the use of steroids and diuretics. Popliteal artery thrombosis in children has been described in cases of traumatic dissection, osteochondroma, Mycoplasma pneumoniae infection, and fibromuscular dysplasia. We report of a 33-month-old girl with bilateral iliac and popliteal arterial thrombosis associated with steroid-resistant NS due to focal segmental glomerulosclerosis. Her treatment involved thrombectomy and intravenous heparinization, followed by oral warfarin for 8 months. Herein, we report a rare case of spontaneous iliac and popliteal arterial thrombosis in a young child with NS.

Non-ischemic cardiomyopathy with focal segmental glomerulosclerosis

“…Health-care providers should be aware of the cardiac complications of FSGS, and high index of suspicion should be kept in mind for the appropriate clinical scenario. Though in pediatrics, bilateral iliac and popliteal arterial thrombosis [16] as well as pulmonary embolism [17] have been documented, to our knowledge, this is the only case of FSGS in adult population that presented with left ventricular thrombus.…”

Urokinase prophylactic anticoagulation in children with nephrotic syndrome: a multicenter retrospective cohort study

“…A number of observational studies have found that the high risk factors of thrombosis in children with NS mainly include the age of onset (≥ 12 years) [ 18 , 19 ], indwelling intravenous catheter [ 18 , 20 – 22 ], complicated by infection [ 23 ], persistent severe hypoproteinemia (< 20 g/l) [ 22 , 24 ], hyperlipidemia [ 20 , 21 , 25 , 26 ], hyperfibrinogenemia [ 19 , 22 ], platelets (Plt) > 300 × 10 9 /l [ 19 , 27 ], glucocorticoids application [ 19 , 28 ], ATIII < 80% [ 20 , 22 , 24 ], Ddimer > 1 mg/l [ 24 , 29 ], and diuretics application [ 19 , 28 ]. The occurrence of thrombosis often indicates a poor prognosis, and many cases of disability and even death have been reported in the literature at home and abroad [ 30 – 35 ]. However, the potential adverse reactions to anticoagulants make the prophylactic use of anticoagulants in children with NS controversial.…”