Thromboembolism in the Nephrotic Syndrome

Egli, F; Elmiger, P; Stalder, G

doi:10.1203/00006450-197411000-00049

Cited by 43 publications

(33 citation statements)

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“…Both arterial and venous thrombosis has been reported with common sites being the pulmonary artery, renal vein, deep leg veins, inferior vena cava, and femoral iliac artery [54,56,57]. Other sites include the cerebral and meningeal arteries, mesenteric and hepatic veins [54,56,58,59].…”

Section: (Ii) Thromboembolismmentioning

confidence: 99%

“…The incidence of thrombotic complications is between 2 and 3 percent [54]. Both arterial and venous thrombosis has been reported with common sites being the pulmonary artery, renal vein, deep leg veins, inferior vena cava, and femoral iliac artery [54,56,57].…”

Section: (Ii) Thromboembolismmentioning

confidence: 99%

“…Factors that increase the risk of thromboembolism in children with NS include: hemoconcentration; immobility (common in patients with anasarca); severe infections; and a hypercoagulable state (due to thrombocytosis; decrease levels of antithrombin III, free proteins, and plasminogen from increased urinary loss); increased platelet activation, hyperfibrinogenemia; high molecular weight fibrinogen moieties in the circulation [54,55].…”

Section: (Ii) Thromboembolismmentioning

confidence: 99%

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Steroid Sensitive Nephrotic Syndrome in Children

Bhimma¹

2014

J Nephrol Ther

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Nephrotic Syndrome (NS) is one of the most frequent glomerular diseases seen in children. Children who go into complete remissin following treatment with corticosteroids are classified as having "steroid sensitive" NS. In developed countries over 80% of children with idiopathic NS have steroid sensitive disease although response to steroids is somewhat tempered in developing countries, especially in black children, the majority of whom have steroid resistant disease.The exact pathogenesis of this condition remains elusive. Podocyte injury and proteinuria are the two main issues in the pathogenesis. Recent studies suggest alterations in both innate and adaptive immune responses. There is release of cytokines by T-cells as well as a strong contribution of B-cell immunity. Genetic studies have reported human leucocyte antigen (HLA) class II antigens DR and DQ associations linked to steroid sensitive NS and in small case studies, single gene mutations e.g. PLCE1 although to date no homozygous mutations in NPHS1 or NPHS2 and WT-1 genes have been reported.Most children with steroid sensitive NS have multiple relapses and a significant percentage also develop steroid dependent NS. These children receive multiples courses of steroids and are at high risk of developing steroid toxicity. Patient with frequent relapses who develop steroid dependency thus require alternative treatment. Steroids sparing agents used include levamisole, cyclophosphamide, mycophenolate mofetil (MMF), calcineurin inhibitors (cyclosporine and tacrolimus), rituximab and vincristine. The steroid-sparing effects of these agents have greatly reduced the adverse effects seen with long-term use of steroids.Despite the wide arsenal of agents available, therapy needs to be individualised to achieve optimal care of each child. More randomised controlled trials are required to evaluate the therapeutic and economic efficacy of this agent, define criteria for selection of patients for use of particular agents and to determine the safety profile of these drugs in children.This article reviews the epidemiology, pathogenesis, clinical presentation, diagnosis, complications, management and long term outcome of children with steroid sensitive NS.

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Section: (Ii) Thromboembolismmentioning

confidence: 99%

Section: (Ii) Thromboembolismmentioning

confidence: 99%

Section: (Ii) Thromboembolismmentioning

confidence: 99%

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Steroid Sensitive Nephrotic Syndrome in Children

Bhimma¹

2014

J Nephrol Ther

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“…Fishberg [7] drew general attention to the arterial thrombi for the first time. Whereas children show about an equal incidence of arterial and venous thrombosis [6], in adults arterial thrombosis is much less common than venous thrombosis [8]. Nolasco et al [9] in a series of 89 adult minimal change nephrotics found that 11 had deep venous thrombosis whereas only 1 had arterial thrombosis of the femoral artery.…”

Section: Introductionmentioning

confidence: 99%

“…Since then a number of reports have appeared highlighting the association of both venous and arterial thrombosis in patients with nephrotic syndrome [2][3][4][5][6]. Fishberg [7] drew general attention to the arterial thrombi for the first time.…”

Section: Introductionmentioning

confidence: 99%

Intraventricular and Brachial Artery Thrombosis in Nephrotic Syndrome

Malik

Al-Wakeel²,

Al-Mohaya³

et al. 1998

Am J Nephrol

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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.

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Simultaneous manifestation of acute myocardial infarction and nephrotic syndrome

Meyer

Schulze

Gröne

et al. 1998

Clinical Cardiology

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Summary: This report describes the simultaneous manifestation of ischemic heart disease and nephrotic syndrome in a 37-year-old woman presenting with acute anterior myocardial infarction. Symptoms of nephrotic syndrome, such as facial and peripheral edema accompanied by proteinuria and hyperlipidemia, and onset of severe retrostemal pain developed within 24 h. Coronary angiography revealed a complete thrombotic occlusion of the proximal portion of the left anterior descending artery with no evidence of arteriosclerotic lesions. Histologic examination of renal biopsy, including electron microscopy, revealed evidence of minimal change glomerulonephritis. Ultrastructural studies demonstrated widespread effacement of epithelial foot processes. Elevated levels of circulating fibrinogen appeared to be an important factor for the hypercoagulable state in this patient, suggesting a causative relationship between coronary thrombosis and nephrotic syndrome.

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Thromboembolism in the Nephrotic Syndrome

Cited by 43 publications

References 0 publications

Steroid Sensitive Nephrotic Syndrome in Children

Steroid Sensitive Nephrotic Syndrome in Children

Intraventricular and Brachial Artery Thrombosis in Nephrotic Syndrome

Simultaneous manifestation of acute myocardial infarction and nephrotic syndrome

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