Kaohsiung Journal of Medical Sciences
Volume 26, Issue 2 , Pages 89-95, February 2010

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

  • Szu-Chia Chen

      Affiliations

    • Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
  • ,
  • Wan-Chun Liu

      Affiliations

    • Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
  • ,
  • Cheng-Hsueh Lee

      Affiliations

    • Ming-Kang Clinic, Kaohsiung, Taiwan
  • ,
  • Jer-Ming Chang

      Affiliations

    • Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
    • Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Corresponding Author InformationAddress 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
  • ,
  • Hung-Chun Chen

      Affiliations

    • Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

Received 2 April 2009; accepted 26 May 2009.

Article Outline

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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PII: S1607-551X(10)70013-9

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

Kaohsiung Journal of Medical Sciences
Volume 26, Issue 2 , Pages 89-95, February 2010