Acute arterial thrombosis with antithrombin III deficiency in nephrotic syndrome: Report of a case

Abstract

Nephrotic syndrome frequently causes venous thromboembolic complications. Arterial thrombosis has rarely been reported and is mainly observed in children. Only six cases of lower extremity arterial thrombosis in adults have been reported in the literature. The outcome in these cases was unsatisfactory because of the high rates of limb loss and recurrence of thrombosis. We report successful treatment of a 39-year-old man who suffered from right lower extremity arterial thrombosis associated with decreased levels of serum antithrombin III. He was admitted to our hospital with severe pain in his right foot. No pulse was palpable in his right dorsalis pedis or posterior tibial arteries. His right foot was cold and mottled, with a reduced sensation and motor activity. The laboratory data revealed a serum total protein concentration of 3.9g/dl and an albumin concentration of 1.5 g/dl. The coagulation profile showed a fibrinogen level of 879 mg/dl and antithrombin III value of 9.5%. Right lower extremity arteriography showed a complete occlusion of the right deep femoral artery and popliteal artery, and a filling defect in the common femoral artery. An emergency thrombectomy was performed under general anesthesia. The patient was treated successfully, and surgical treatment was followed by anticoagulant therapy with 1,000 units of antithrombin III. A renal biopsy revealed histologic evidence of minimal change of glomerulonephritis. He was discharged 3 months later, and no recurrence of thrombosis has yet been observed.

A Case of Acute Arterial Thrombosis Caused by Nephrotic Syndrome

“…thrombosis despite the infusion of heparin (10,000 units/ day) and prostaglandin E1 (80 μg/day) on the first postoperative day. Moreover, as argatroban was not influenced by the value of antithrombin III, which plays a major role in the increased risk of thrombosis in patients with nephrotic syndrome, 1,2) after the reoperation the infusion of argatroban (20 mg/day) as well as heparin (15,000 units/ day) was started for this patient with the lower value of antithrombin III. Kauffmann et al 6) studied antithrombin III levels in relation to the occurrence of thromboembolism in 48 patients with various degrees of proteinuria.…”

“…1) Thrombosis involving the arterial system is rare, and has mainly reported in nephritic children. 4,5) Nishimura et al 1) reviewed lower extremity arterial thrombosis with adult nephritic syndrome. Three of seven cases resulted in amputation of the leg, and two of these three also sustained recurrent thrombosis.…”

“…[1][2][3] We describe the successful surgical treatment of a case of acute arterial thrombosis caused by nephrotic syndrome.…”

Acute arterial thromboembolic treatment in an infant patient with nephrotic syndrome and antithrombin III deficiency

“…Ancak bu olgularda AT III'ün normal seviyelerde olması durumunda heparin etkili olabilmektedir. [3,6] Bu nedenle AT III seviyesinin hastamızda düşük olması nedeni ile embolektomi öncesinde AT III uygulamasına intravenöz olarak başlandı. Ameliyat sırasında da intraarteriyel TPA uygulanmasına karar verildi.…”

“…Akut tromboemboli tedavisinde cerrahi tromboembolektomi tercih edilen bir yön-temdir ancak çocuklarda embolektomi çok sınırlıdır. [5,6] Doku plasminojen aktivatörü (tissue plasminogen activator, TPA) doğal serin proteazdır. Ürokinaz ile karşılaştırıldığında TPA'nın plasminojeni daha güçlü aktive ettiği bildirilmiştir.…”