Mesenteric thrombosis causing short bowel syndrome in nephrotic syndrome

Ulinski, Tim; Guigonis, Vincent; Baudet-Bonneville, Valérie; Auber, F.; Garcette, K.; Bensman, A

doi:10.1007/s00467-003-1281-3

Cited by 19 publications

(17 citation statements)

References 16 publications

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“…54 Higher risk of venous thrombotic events (VTEs) and arterial thrombotic events (ATEs) has been demonstrated within the first 6 months of NS diagnosis in adults, 55 and in relation to administered drugs, steroid-sensitive NS had a lower risk of thromboembolism than steroid-resistant NS. 56…”

Section: Thrombosis In Nephrotic Syndromementioning

confidence: 99%

Thrombosis in Nephrotic Syndrome

Barbano

Gigante

Amoroso

et al. 2013

Semin Thromb Hemost

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Nephrotic syndrome (NS) is characterized by heavy proteinuria, edema, hypoalbuminemia, and hyperlipidemia and the most frequent causes are glomerular diseases. An uncommon presentation is iatrogenic NS, an adverse effect of some drugs administration. In the clinical course of NS, a typical feature is dysregulated coagulation state, promoted by the breakdown of permselectivity barrier of the glomerular capillary wall, resulting in the leakage of high-molecular-mass proteins, at least the size of albumin. This hypercoagulable condition is supported by several factors, such as abnormalities in platelet activation and an imbalance between anticoagulation/antithrombosis and procoagulant/prothrombotic mechanisms. Thus, NS and the risk of developing thromboses are strictly related. Thrombotic events affect the venous system rather than arterial vessels with different features and frequencies. Deep venous system of the lower extremities and renal veins are the most frequent source of pulmonary embolism, the most dangerous NS complication. Prophylactic anticoagulation and thrombosis treatment are not clearly established because large randomized trials and guidelines are lacking. The management of NS and the decision of when and how to anticoagulate the patient represent a teamwork challenge for physicians.

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Section: Thrombosis In Nephrotic Syndromementioning

confidence: 99%

Thrombosis in Nephrotic Syndrome

Barbano

Gigante

Amoroso

et al. 2013

Semin Thromb Hemost

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“…It is also known that there is higher risk of TE in steroid-resistant NS than in steroid-sensitive NS12).…”

Section: Nephrotic Syndrome-related Complicationsmentioning

confidence: 99%

Complications of nephrotic syndrome

2011

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Nephrotic syndrome (NS) is one of the most common glomerular diseases that affect children. Renal histology reveals the presence of minimal change nephrotic syndrome (MCNS) in more than 80% of these patients. Most patients with MCNS have favorable outcomes without complications. However, a few of these children have lesions of focal segmental glomerulosclerosis, suffer from severe and prolonged proteinuria, and are at high risk for complications. Complications of NS are divided into two categories: disease-associated and drug-related complications. Disease-associated complications include infections (e.g., peritonitis, sepsis, cellulitis, and chicken pox), thromboembolism (e.g., venous thromboembolism and pulmonary embolism), hypovolemic crisis (e.g., abdominal pain, tachycardia, and hypotension), cardiovascular problems (e.g., hyperlipidemia), acute renal failure, anemia, and others (e.g., hypothyroidism, hypocalcemia, bone disease, and intussusception). The main pathomechanism of disease-associated complications originates from the large loss of plasma proteins in the urine of nephrotic children. The majority of children with MCNS who respond to treatment with corticosteroids or cytotoxic agents have smaller and milder complications than those with steroid-resistant NS. Corticosteroids, alkylating agents, cyclosporin A, and mycophenolate mofetil have often been used to treat NS, and these drugs have treatment-related complications. Early detection and appropriate treatment of these complications will improve outcomes for patients with NS.

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“…8,11 Although the risk of thrombotic events in children with NS might be lower, there is evidence that the implications of such events are greater in children. Ulinski et al 13 in their reports found mesenteric thrombosis which was responsible for a 240 cm small bowel necrosis of a 7-year-old boy, necessitating bowel resection. In the study of Hoyer et al 11 in which 26 children with NS were evaluated with pulmonary ventilation and perfusion studies during remission, a surprising 26.9% had evidence of pulmonary embolism.…”

Section: Discussionmentioning

confidence: 98%

Fibrinogen status in relapse and remission of childhood nephrotic syndrome

Limantara¹,

Mudita²,

Suarta³

2016

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Objective To evaluate fibrinogen concentration of relapsing neph-rotic syndrome (NS) in children, and to investigate relationshipbetween fibrinogen with albumin and cholesterol.Methods A cross-sectional study among NS patients admitted topediatric outpatient clinic and pediatric ward at Sanglah Hospital,Denpasar, from November 1, 2003 to January 31, 2004. All pa-tients were evaluated for clinical and laboratory findings of relapseand remission, including edema, proteinuria, serum albumin, totalcholesterol, as well as total platelet count and fibrinogen concen-tration to evaluate coagulation parameters in nephrotic patients.Results There were 36 patients with the mean age of 7.4 (SD 2.3)years included in this study. Mean fibrinogen concentration in re-lapse state was 671.8 (SD 102.7) mg/dl, while in remission statewas 255.2 (SD 50.5 mg/dl); the mean difference was 416.6 mg/dl(95% CI 362.9;470.4; P<0.001). Fibrinogen was inversely andstrongly correlated with serum albumin concentrations (r=-0.91;P<0.001). Fibrinogen was positively and strongly correlated to to-tal cholesterol (r=0.80; P<0.001). Using multiple regression analy-sis, it was shown that only relapse/remission status was signifi-cantly associated with fibrinogen concentration (P<0.001).Conclusion Fibrinogen status is significantly correlated with re-lapse and remission status of NS in childhood patients.

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Mesenteric thrombosis causing short bowel syndrome in nephrotic syndrome

Cited by 19 publications

References 16 publications

Thrombosis in Nephrotic Syndrome

Thrombosis in Nephrotic Syndrome

Complications of nephrotic syndrome

Fibrinogen status in relapse and remission of childhood nephrotic syndrome

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