Multiple venous thrombosis and massive pulmonary artery thrombus as the presenting features of steroid-responsive nephrotic syndrome

Peces, R; Pobes, A; Rodríguez, Maria Teresa Jaldo; Navascués, R Alvarez; Ortega, F; Alvarez-Grande, J

doi:10.1093/ndt/14.5.1306

Cited by 11 publications

(8 citation statements)

References 8 publications

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“…The association of membranous nephropathy and renal vein thrombosis is perhaps best known but venous thrombosis may occur at any site and with other causes of nephrotic syndrome. Venous thromboembolism may also be the presenting feature of nephrotic syndrome,3 4 in which case failure to dip the urine or to appreciate the significance of a low serum albumin in a patient with deep vein thrombosis (DVT) or pulmonary embolus (PE) may lead to a significant delay in diagnosis, as illustrated by the following case.…”

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confidence: 99%

Nephrotic syndrome presenting as deep vein thrombosis or pulmonary embolism

Ambler

Irvine

Selvarajah

et al. 2008

Emergency Medicine Journal

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A patient presenting with a swollen left leg and pleuritic chest pain was shown to have deep vein thrombosis (DVT) by Doppler studies. He was anticoagulated but required two further admissions with swelling of both legs before a diagnosis of nephrotic syndrome was considered and confirmed. Renal biopsy showed that this was caused by membranous nephropathy. Two audits were subsequently conducted. The first was of diagnostic discharge codes for nephrotic syndrome and venous thromboembolism in south west Scotland (population 147,000) from 1997 to 2006. A diagnosis of nephrotic syndrome was confirmed in 32 patients, four (12.5%) of whom (including the index case) had presented with DVT (two) or pulmonary embolus (PE) (two). A second audit of 98 consecutive patients with Doppler-positive lower limb DVT presenting to A&E in Dumfries from July 2005 to July 2006 showed that the urine had been tested for protein in one case only. Although nephrotic syndrome remains an uncommon cause of DVT or PE, it is complicated by venous thromboembolism sufficiently frequently for the diagnosis to be considered in all patients with DVT or PE, for whom the take-home message should simply be-Don't forget to dip the urine or ignore a low serum albumin.

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confidence: 99%

Nephrotic syndrome presenting as deep vein thrombosis or pulmonary embolism

Ambler

Irvine

Selvarajah

et al. 2008

Emergency Medicine Journal

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“…In our review, we found few cases which were presented with deep vein thrombosis and pulmonary thromboembolism. 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).…”

Section: Discussionmentioning

confidence: 98%

“…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.…”

Section: Discussionmentioning

confidence: 99%

IgA nephropathy presenting with pulmonary thromboembolism and renal artery infarct

et al. 2018

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Background: Venous and arterial thromboembolism are frequently seen in nephrotic syndrome. They generally occur during periods of sustained proteinuria in patients who are not responding to treatment and more commonly seen in minimal change disease and membranous nephropathy. Case Presentation: A 28-year-old male presented to cardiology department of our hospital with worsening breathlessness for 1 week. We found pulmonary embolism and an infarct in the lower pole of the right kidney by CT pulmonary angiogram. He had no previous history or features of nephrotic syndrome. Urine analysis showed numerous red blood cells, 3+ proteinuria and granular casts. Urine protein creatinine ratio was 5.2 g/g of creatinine. Serum creatinine was 2.61 mg/dL. Renal biopsy was suggestive of IgA nephropathy and patient was started on steroids and warfarin and responded to treatment. Conclusions: Patients with nephrotic syndrome can rarely present initially with venous and arterial thromboembolism. Rarely even IgA nephropathy can present with such thromboembolic episodes.

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“…Various organ manifestations have been reported. Deep leg vein thrombosis resulting in pulmonary embolism is by far the most common, ranging from clinically silent to life-threatening forms [4,7,8,9]. Cerebral venous thrombosis resulting in hemiparesis, aphasia, or even death [10], and renal vein thrombosis [4,11] are frequent.…”

Section: Introductionmentioning

confidence: 99%

Mesenteric thrombosis causing short bowel syndrome in nephrotic syndrome

Ulinski

Guigonis

Baudet-Bonneville

et al. 2003

Pediatric Nephrology

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Nephrotic patients are at risk of developing venous and arterial thrombotic complications. Pulmonary embolism due to affected deep leg veins is by far the most common event. Renal or cerebral vein thromboses have been described. Thrombosis of arterial vessels is less frequent. Mesenteric infarction is a rare but severe complication in patients with nephrotic syndrome (NS). We report a 7-year-old boy with a steroid-dependent (SD) NS and a homozygous mutation of methylenetetrahydrofolate reductase, increasing the risk of thromboembolic events. He developed a thrombosis of his superior mesenteric artery during his ninth relapse, which was responsible for a necrosis of 240 cm of his small bowel, necessitating resection of necrotic parts and double external ostomy diversion. Remission was achieved with pulse prednisolone therapy. Corticoids were reduced over 4 months progressively. Oral cyclosporin A (CyA) was initiated for long-term treatment. Due to a short bowel syndrome with severe malabsorption, even oral administration of 22.5 mg/kg per day CyA did not lead to sufficient plasma levels. Intravenous cyclophosphamide pulse therapy over 6 months led to a complete remission. No relapse occurred over a period of more than 5 months after the last cyclophosphamide pulse. Anticoagulation and screening for increased susceptibility for thrombotic events are necessary in every nephrotic patient. Intravenous cyclophosphamide pulse therapy is a useful alternative in SDNS with impaired intestinal absorption of applied immunosuppressive drugs.

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Multiple venous thrombosis and massive pulmonary artery thrombus as the presenting features of steroid-responsive nephrotic syndrome

Cited by 11 publications

References 8 publications

Nephrotic syndrome presenting as deep vein thrombosis or pulmonary embolism

Nephrotic syndrome presenting as deep vein thrombosis or pulmonary embolism

IgA nephropathy presenting with pulmonary thromboembolism and renal artery infarct

Mesenteric thrombosis causing short bowel syndrome in nephrotic syndrome

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