Intraventricular and Brachial Artery Thrombosis in Nephrotic Syndrome

Abstract

A 23-year-old Saudi female presented with nephrotic syndrome. On renal biopsy she had primary focal and segmental glomerulosclerosis which was resistant to steroids. Two years later she presented with absent left arm pulses and on investigation a diagnosis of left ventricular thrombosis and thromboembolism of left brachial artery was made. Low antithrombin III, high fibrinogen levels and diuretic therapy were the possible causative factors for hypercoagulable state. On anticoagulation therapy initiated with heparin and continued with warfarin for 8 weeks there was complete dissolution of intraventricular and improvement of left brachial artery thrombosis. An early diagnosis and treatment of this potentially serious complication of nephrotic syndrome are stressed.

Asymptomatic intracardiac thrombus in steroid-sensitive nephrotic syndrome

“…Renal vein thrombosis is a frequent complication in adults [7,8], but most severe sequelae are caused by cerebral venous thromboses [9], resulting in hemiparesis, headache, aphasia, massive cerebral infarction, or even death [10]. Apart from venous thromboses the arterial vessels can also be affected, such as the brachial arteries [11] or even the abdominal aorta [12]. Intracardiac thrombi have so far only been described on autopsy.…”

Brachiocephalic artery thrombosis in adult nephrotic syndrome

“…[891112] Increased blood viscosity due to hemoconcentration contributes to occurrence of thromboembolic complications, which is often aggravated by the use of diuretics. [7] Steroids shorten prothrombin as well as accelerate partial thromboplastin times that aggravate the hypercoagulable state of nephrotic syndrome.…”

The Nephrotic Syndrome: An Unusual Case of Multiple Embolic Events

“…Intracardiac thrombosis is one of the rarest thrombotic complications of the nephrotic syndrome. In the English literature, we identified 7 such cases, [3][4][5][6][7][8][9] 3 of which were complicated by embolization to, in each case, either cerebral vasculature, brachial artery, or popliteal artery. We have not identified another case report that involved a cardiac thrombus and embolization to more than 1 site.…”

“…As previously noted in other case reports involving patients with nephrotic syndrome and arterial thromboembolic events, a TEE should be performed to look for evidence of cardiac thrombosis. [3][4][5] Results of this procedure may have an important impact on the types of therapeutic interventions considered to treat the acute ischemic event. We elected to proceed with open operative intervention when faced with an ischemic left arm because we had knowledge that the patient had a left-hand side cardiac thrombus that might further embolize with the use of thrombolytics.…”

“…2 Even more unusual is intracardiac thrombus with peripheral embolization; only a handful of case reports appear in the literature. [3][4][5] Here, we describe a 42-year-old woman with a recent diagnosis of nephrotic syndrome who presented with a pulseless right lower extremity, a renal infarct, and a thrombus in her left atrial appendage. After successful surgical intervention for her acute right lower extremity ischemia and heparinization for her hypercoaguable state, the patient developed a cool, pulseless left upper extremity requiring emergent operative intervention.…”