Volume 26, Issue 2, Pages 89-95 (February 2010)

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ABSTRACT

ABSTRACT + REFS

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Nephrotic Syndrome Complicated by Life-Threatening Pulmonary Embolism in an Adult Patient

Received 2 April 2009; accepted 26 May 2009.

We report a 23-year-old male presenting with edema. He was originally admitted for an elective renal biopsy for diagnosis of renal pathology. Unfortunately, because of acute abdominal pain an exploratory laparotomy was done. Progressive azotemia and oliguria then developed, and he required temporary hemodialysis. However, he suffered from sudden-onset severe respiratory distress, and blood gas analysis showed profound hypoxemia with a marked arterial–alveolar oxygen difference. Assessment of a pulmonary embolism by radioisotope imaging was not possible because of his dependence on mechanical ventilation. Subcutaneous low molecular weight heparin and intravenous methylprednisolone were given to treat the presumed pulmonary embolism and the underlying nephrotic syndrome. His partial oxygen level gradually increased after continuous heparin and steroid administration. Complete obliteration of one major pulmonary artery and partial obliteration of other smaller arteries were revealed by magnetic resonance angiography. He was discharged and followed-up as an outpatient, and was given oral warfarin and prednisolone. Follow-up magnetic resonance angiography 5 months later showed a normal pulmonary tree with no residual lesions.

Key Words: low molecular weight heparin , nephrotic syndrome , pulmonary arterial thromboembolism

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Article Outline

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References

1. 1 Gitlin D , Janeway CA , Farr LE . Studies on the metabolism of plasma proteins in the nephrotic syndrome. I. Albumin, gamma-globulin and iron-binding globulin . J Clin Invest . 1956;35:44–56 . MEDLINE | CrossRef

2. 2 Kaysen GA , al Bander H . Metabolism of albumin and immunoglobulins in the nephrotic syndrome . Am J Nephrol . 1990;10(Suppl 1):36–42 . CrossRef

3. 3 Harris RC , Ismail N . Extrarenal complications of the nephrotic syndrome . Am J Kidney Dis . 1994;23:477–497 . Abstract

4. 4 Cameron JS . Coagulation and thromboembolic complications in the nephrotic syndrome . Adv Nephrol Necker Hosp . 1984;13:75–114 . MEDLINE

5. 5 Llach F . Hypercoagulability, renal vein thrombosis, and other thrombotic complications of nephrotic syndrome . Kidney Int . 1985;28:429–439 . MEDLINE | CrossRef

6. 6 Rabelink TJ , Zwaginga JJ , Koomans HA , et al. Thrombosis and hemostasis in renal disease . Kidney Int . 1994;46:287–296 . MEDLINE | CrossRef

7. 7 Llach F , Papper S , Massry SG . The clinical spectrum of renal vein thrombosis: acute and chronic . Am J Med . 1980;69:819–827 . Abstract | Full-Text PDF (2649 KB) | CrossRef

8. 8 Abrass CK . Clinical spectrum and complications of the nephrotic syndrome . J Investig Med . 1997;45:143–153 . MEDLINE

9. 9 Addis T , Gray H , Barrett E . Food protein effect on plasma specific gravity, plasma protein, and hematocrit value . J Exp Med . 1948;87:353–368 . CrossRef

10. 10 Citak A , Emre S , Sairin A , et al. Hemostatic problems and thromboembolic complications in nephrotic children . Pediatr Nephrol . 2000;14:138–142 . CrossRef

11. 11 Singhal R , Brimble KS . Thromboembolic complications in the nephrotic syndrome: pathophysiology and clinical management . Thromb Res . 2006;118:397–407 . Abstract | Full Text | Full-Text PDF (167 KB) | CrossRef

12. 12 Parag KB , Somers SR , Seedat YK , et al. Arterial thrombosis in nephrotic syndrome . Am J Kidney Dis . 1990;15:176–177 . Abstract

13. 13 Tarry WC , Moser AJ , Makhoul RG . Peripheral arterial thrombosis in the nephrotic syndrome . Surgery . 1993;114:618–623 . MEDLINE

14. 14 Ahmed K , Saeed E . Nephrotic syndrome and pulmonary artery thrombosis . Am J Nephrol . 1995;15:274–276 . MEDLINE | CrossRef

15. 15 Huang J , Yang J , Ding J . Pulmonary embolism associated with nephrotic syndrome in children: a preliminary report of 8 cases . Chin Med J (Engl) . 2000;113:251–253 . MEDLINE

16. 16 Rai Mittal B , Singh S , Bhattacharya A , et al. Lung scintigraphy in the diagnosis and follow-up of pulmonary thromboembolism in children with nephrotic syndrome . Clin Imaging . 2005;29:313–316 . Abstract | Full Text | Full-Text PDF (216 KB) | CrossRef

17. 17 Cherng SC , Huang WS , Wang YF , et al. The role of lung scintigraphy in the diagnosis of nephrotic syndrome with pulmonary embolism . Clin Nucl Med . 2000;25:167–172 . MEDLINE | CrossRef

18. 18 al-Mugeiren MM , Gader AM , al-Rasheed SA , et al. Coagulopathy of childhood nephrotic syndrome— a reappraisal of the role of natural anticoagulants and fibrinolysis . Haemostasis . 1996;26:304–310 . MEDLINE

19. 19 Kauffmann RH , Veltkamp JJ , Van Tilburg NH , et al. Acquired antithrombin III deficiency and thrombosis in the nephrotic syndrome . Am J Med . 1978;65:607–613 . Abstract | Full-Text PDF (688 KB) | CrossRef

20. 20 Vaziri ND , Branson HE , Ness R . Changes of coagulation factors IX, VIII, VII, X, and V in nephrotic syndrome . Am J Med Sci . 1980;280:167–171 . MEDLINE | CrossRef

21. 21 Hoyer PF , Gonda S , Barthels M , et al. Thromboembolic complications in children with nephrotic syndrome. Risk and incidence . Acta Paediatr Scand . 1986;75:804–810 .

22. 22 Zwaginga JJ , Koomans HA , Sixma JJ , et al. Thrombus formation and platelet-vessel wall interaction in the nephrotic syndrome under flow conditions . J Clin Invest . 1994;93:204–211 . MEDLINE | CrossRef

23. 23 Mehls O , Andrassy K , Koderisch J , et al. Hemostasis and thromboembolism in children with nephrotic syndrome: differences from adults . J Pediatr . 1987;110:862–867 . Abstract | Full-Text PDF (452 KB) | CrossRef

24. 24 Fink C , Thieme S , Ley S , et al. MRI of pulmonary embolism . Radiologe . 2007;47:708–715 . CrossRef

25. 25 Ley S , Kauczor HU . MR imaging/magnetic resonance angiography of the pulmonary arteries and pulmonary thromboembolic disease . Magn Reson Imaging Clin N Am . 2008;16:263–273 . Abstract | Full Text | Full-Text PDF (1359 KB) | CrossRef

26. 26 Carson JL , Kelley MA , Duff A , et al. The clinical course of pulmonary embolism . N Engl J Med . 1992;326:1240–1245 . MEDLINE | CrossRef

27. 27 Reid CJ , Segal T . Pulmonary thrombo-embolism in nephrotic syndrome treated with tissue plasminogen activator . Eur J Pediatr . 1997;156:647–649 . MEDLINE | CrossRef

28. 28 Storti S , Pagano L , Marra R , et al. Urokinase and AT-III concentrate treatment in inferior vena cava thrombosis associated with nephrotic syndrome . Blood Coagul Fibrinolysis . 1990;1:743–745 . MEDLINE

29. 29 Bellomo R , Atkins RC . Membranous nephropathy and thromboembolism: is prophylactic anticoagulation warranted? . Nephron . 1993;63:249–254 .

30. 30 Rostoker G , Durand-Zaleski I , Petit-Phar M , et al. Prevention of thrombotic complications of the nephrotic syndrome by the low-molecular-weight heparin enoxaparin . Nephron . 1995;69:20–28 .

31. 31 Wang IK , Lee CH , Yang BY , et al. Low-molecular-weight heparin successfully treating a nephrotic patient complicated by renal and ovarian vein thrombosis and pulmonary embolism . Int J Clin Pract . 2005;59(Suppl):72–75 . MEDLINE | CrossRef

a Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan

b Ming-Kang Clinic, Kaohsiung, Taiwan

c Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

d Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

Address correspondence and reprint requests to: Dr Jer-Ming Chang, Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, 482 San-Ming, Hsiao-Kang District, Kaohsiung 812, Taiwan

PII: S1607-551X(10)70013-9

doi:10.1016/S1607-551X(10)70013-9

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