Evolving presentation of leg cramps in a child with nephrotic syndrome: Answers

Chinnadurai, A.; Marsenić, Olivera

doi:10.1007/s00467-017-3606-7

Cited by 3 publications

(3 citation statements)

References 24 publications

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“…The risk of thromboembolic complications is also increased by dehydration, infection, immobilization, arterial or venous puncture, history of diuretic, or corticosteroid use, presence of hemoconcentration (hemoglobin >14 g/dL), thrombocytosis (>450 × 10 9 platelets/L), severe proteinuria, hypoalbuminemia (<2.0 g/dL), hyperfibrinogenemia, and hypoantithrombinemia (<75%) (1, 3, 4, 8-10). In our case, the bedrest and decreased water intake during influenza B virus infection could have accelerated the thrombogenesis; other risk factors for thrombosis included hypoalbuminemia, hyperfibrinogenemia, and decreased levels of antithrombin III, protein C, and protein S. (8)(9)(10)(11)(12)(13)(14)(15)(16)(17). The median age at the time of the thrombotic event was 8 years (range 1-15 years).…”

Section: Discussionmentioning

confidence: 76%

Childhood Nephrotic Syndrome Complicated by Catastrophic Multiple Arterial Thrombosis Requiring Bilateral Above-Knee Amputation

et al. 2020

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Background: Thromboembolic events are rare but critical complications in childhood nephrotic syndrome. The veins are more commonly affected, while arterial thrombosis is extremely rare but often life-threatening. Herein, we describe the clinical course of a 10-years-old girl with catastrophic multiple arterial thrombosis at the primary onset of nephrotic syndrome who underwent bilateral above-knee amputation. Case diagnosis/treatment: A previous healthy 10-years-old girl contracted the influenza B virus. Five days later, she suddenly developed severe ischemia in both legs. Physical examination showed eyelid and leg edema, and laboratory tests revealed hypoalbuminemia and acute kidney injury. After undergoing contrast-enhanced computed tomography, the patient was diagnosed with multiple arterial thrombosis (including the bilateral iliac arteries) due to nephrotic syndrome. Despite the performance of surgical thrombectomies, fasciotomy, and systematic heparinization, she required bilateral above-knee amputation. The patient achieved spontaneous remission of nephrotic syndrome, and her renal function fully recovered. There were no findings suggestive of secondary nephrotic syndrome and antiphospholipid syndrome. Her protein C and protein S concentrations were slightly decreased at admission. However, whole-exome sequencing revealed a thrombotic risk variant (T630I) in the PROS1 gene encoding protein S. This missense variant is often reported in patients with thrombosis or protein S deficiency, and may result in a thrombotic predisposition in some situations, such as nephrotic syndrome. Conclusions: Arterial thrombosis is a rare complication; however, it must be considered, especially in patients with new-onset nephrotic syndrome. Early recognition is important for early intervention and prevention of serious sequelae.

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Section: Discussionmentioning

confidence: 76%

Childhood Nephrotic Syndrome Complicated by Catastrophic Multiple Arterial Thrombosis Requiring Bilateral Above-Knee Amputation

et al. 2020

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“…According to the literature, most cases of femoral artery thrombosis develop in male adult patients with MCD and the outcome is severely poor, with high rates of limb amputation and even patient death . Recently, Chinnadurai and Marsenic reported on an 8‐year‐old boy with NS who developed acute artery thrombosis in the right lower extremity during the first relapse . Despite the fact that he complained of right leg cramps 2 days before the first admission, the patient was immediately discharged home because of transient pain improvement after acetaminophen.…”

mentioning

confidence: 99%

“…3,4 Recently, Chinnadurai and Marsenic reported on an 8-year-old boy with NS who developed acute artery thrombosis in the right lower extremity during the first relapse. 5 Despite the fact that he complained of right leg cramps 2 days before the first admission, the patient was immediately discharged home because of transient pain improvement after acetaminophen. Unfortunately, although the patient underwent surgical thrombolysis followed by anticoagulation therapy, his toes developed gangrene due to compartment syndrome after the procedure, and amputation of all five digits of the foot was required.…”

mentioning

confidence: 99%