Nephrotic syndrome presenting as deep vein thrombosis or pulmonary embolism

Abstract

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.

Pulmonary Embolism Revealing Idiopathic Membranous Glomerulonephritis

“…In our case, pulmonary embolism was the first presenting feature of the nephrotic syndrome. It was even reported by Hartland et al [6], Peces et al [7] and Ambler et al [8]. No other site of thrombosis was detected in our patient.…”

Analysis of risk factors for recurrence of deep venous thrombosis in lower extremities

“…However, multivariate analysis showed mixed DVT was not a risk factor for DVT relapse. The fact that patients with concomitant diabetes, SLE, or NS are more likely to develop DVT has been widely accepted [31–33]. Univariate analysis showed the incidence of DVT relapse in patients with these internal diseases was about 1.5 times higher than that in other patients, but in regression analysis these diseases had no influence on the DVT relapse ( P diabetes =0.298; P SLE =0.076; P NS =0.090).…”

Relationship between proteinuria and venous thromboembolism

“…This is based on several case studies and retrospective studies [8][9][10][11]. One retrospective study demonstrated that patients with nephrotic syndrome are more than twice as likely to develop DVT compared to the non-nephrotic population [11].…”