Cerebral Venous Sinus Thrombosis in a Child with Idiopathic Nephrotic Syndrome: a case report

Silva, Ana Isabel Rodrigues; Tavares, João Manuel Ribeiro da Silva; Vaz, Ana Sofia; Brito, Nádia; Vasconcelos, Mónica; Sevivas, Teresa; Moura, Lurdes; Cordinhã, Carolina

doi:10.1590/2175-8239-jbn-2018-0009

Cited by 4 publications

(4 citation statements)

References 18 publications

(20 reference statements)

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“…In our study, 1 of 2 subjects with SMV thrombosis experienced intestinal necrosis, and he survived after the resection of the necrotic bowel. CVS thrombosis is another severe type of thrombosis [ 22 ]. In our study, 1 subject with CVS thrombosis had persistent intracranial hypertension that could not be relieved after standard anticoagulation therapy.…”

Section: Discussionmentioning

confidence: 99%

Spectrum of thrombotic complications and their outcomes in Chinese children with primary nephrotic syndrome

Guan

Ding

et al. 2020

Ital J Pediatr

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Background Thromboembolism is a life-threatening, limb-threatening or organ-threatening complication that occurs in patients with primary nephrotic syndrome (NS). There are few studies on the spectrum, complications and outcomes of thrombosis in children with NS. This study aimed to determine the spectrum of thrombosis and its relationship with the nephrotic state, treatment and outcomes in children and adolescents with primary NS. Methods The medical records of subjects aged 1–18 years with NS complicated with thromboembolism treated at our centre within the last 26 years were retrieved. Data on the status of NS, site, symptoms and signs, laboratory investigations, diagnosis, treatment, complications and outcomes of thrombosis were collected and reviewed retrospectively. A severe complication was defined as a condition associated with thrombosis requiring a special diagnostic modality to confirm or a specific treatment such as surgical intervention. The outcome of thrombosis was defined as the status of thrombosis, as determined by imaging methods and the functional status with respect to the anatomic sites of thrombosis at the last follow-up. The permanent dysfunction of an organ or limb related to thrombosis was defined as a sequela. Results We observed thrombosis in 1.4% (27/1995) of subjects with NS during the study period. There were 27 subjects with thrombosis, including 21 males and 6 females. Thrombosis was observed in 51.9% (14/27) of the study participants with steroid resistant NS. Most episodes of thrombosis occurred during the active stage of NS; however, 7.4% of thrombosis cases occurred during the remission of proteinuria. Renal vein thrombosis (33.3%) and pulmonary embolism (25.9%) were the most common types of thrombosis. Among the 17 subjects biopsied, minimal change disease and membranous nephropathy were the two most common findings. Six (22.2%) subjects experienced severe complications or sequelae; 1 had persistent intracranial hypertension, 1 had intestinal perforation, 1 had hypoxemia and pulmonary hypertension, 1 had lameness, 1 had epilepsy, and 1 had an askew mouth due to facial paralysis. In 19 (70.4%) subjects, the symptoms resolved completely or improved without severe complications or sequelae. Conclusions Thrombosis mostly occurred in males of school age during the active stage of NS. Renal vein thrombosis and pulmonary embolism were the most common types of thrombosis. In most patients with thrombosis, the symptoms improved completely without complications with standard anticoagulation therapy. However, 22.2% had severe complications or sequelae requiring an advanced diagnostic modality and aggressive treatment.

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Section: Discussionmentioning

confidence: 99%

Spectrum of thrombotic complications and their outcomes in Chinese children with primary nephrotic syndrome

Guan

Ding

et al. 2020

Ital J Pediatr

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“…The most common site of CVST was the superior sagittal sinus. Intravenous heparin followed by oral warfarin is the treatment of choice in most studies 2 3 8 13–19. The various studies have been summarised in table 2.…”

Section: Discussionmentioning

confidence: 99%

Sixth cranial nerve palsy and dense cerebral venous sinus thrombosis in a child with nephrotic syndrome

2023

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Nephrotic syndrome (NS) is a common glomerular disease characterised by massive proteinuria, hypoalbuminaemia, oedema and hyperlipidaemia. Cerebral venous sinus thrombosis (CVST) is a rare complication in children with NS. Here, we report a case of relapsing NS on steroid therapy, in a male in early childhood who presented with symptoms of headache, vomiting and double vision. On prism cover test there was 25 PD esotropia with abduction restriction in the left eye. Fundus examination showed bilateral papilloedema. He was diagnosed as sixth cranial nerve palsy of left eye. Neuroimaging reported dense CVST. He was managed with subcutaneous low molecular weight heparin and steroids. After 2 months of treatment, there was a complete resolution of esotropia and optic disc oedema. This case highlights the importance of early diagnosis of acute onset esotropia and sagittal sinus thrombosis in a case of NS.

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“…We searched databases using the following terms: “child” and “nephrotic syndrome” and “cerebral venous sinus thrombosis” or “cerebral sinovenous thrombosis.” The publication date was set between 1989 and 2019. Nine articles were retrieved (Table 2 ) [ 1 - 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…The review of the international literature [1][2][3][4][5][6][7][8][9] reveals that the majority of patients are male. Although their clinical manifestations are diverse, they mostly present with headache and vomiting.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Venous Sinus Thrombosis in a Child With Idiopathic Nephrotic Syndrome: A Case Report and Review of the Literature

He¹,

Yang²

2020

Cureus

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Cerebral venous sinus thrombosis is a rare and serious complication of nephrotic syndrome. A case of a five-year-old boy with nephrotic syndrome is described here. On the fourth day of admission, the child developed an occasional cough. A percutaneous renal biopsy was conducted to characterize the frequent-relapse nephrotic syndrome that was developed. After suspension of oral anticoagulants, the patient developed mild dizziness, headache, and vomiting. The child was diagnosed with intracranial venous sinus thrombosis based on data obtained using head computed tomography and magnetic resonance imaging. He recovered after receiving heparin and warfarin anticoagulants. We summarized the case and reviewed the literature here, showing that early diagnosis and treatment have a significant impact on the prognosis of this complication.

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Cerebral Venous Sinus Thrombosis in a Child with Idiopathic Nephrotic Syndrome: a case report

Cited by 4 publications

References 18 publications

Spectrum of thrombotic complications and their outcomes in Chinese children with primary nephrotic syndrome

Spectrum of thrombotic complications and their outcomes in Chinese children with primary nephrotic syndrome

Sixth cranial nerve palsy and dense cerebral venous sinus thrombosis in a child with nephrotic syndrome

Cerebral Venous Sinus Thrombosis in a Child With Idiopathic Nephrotic Syndrome: A Case Report and Review of the Literature

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