Ischemic Stroke of Possible Embolic Etiology Associated With Nephrotic Syndrome

Unilateral transient watershed cerebral infarct in a 6-year-old girl with frequently relapsing nephrotic syndrome

“…Although venous and arterial thrombosis has been reported widely among children with nephrotic syndrome. [ 3 5 ] Another postulate of this transient watershed infarction could be hypertension associated with nephrotic syndrome, especially on treatment with antihypertensives. It is well known that such transient cerebral vessel abnormalities among hypertensive patients are clubbed under PRES.…”

“…Nephrotic syndrome is one of the hypercoagulable states that results from changes in platelet activation and aggregation, impaired fibrinolysis resulting from urinary loss of plasminogen, and hypoalbuminemia-induced increased synthesis of clotting factor. [ 3 ] Hence, children with nephrotic syndrome are prone to both venous sinus thrombosis as well as arterial thrombosis. However, unilateral watershed infarcts are uncommon among children with nephrotic syndrome, especially in the absence of hypotensive hypovolemic state and arterial stenosis.…”

Direct-Acting Oral Anticoagulants as Prophylaxis Against Thromboembolism in the Nephrotic Syndrome

“… 3 , 4 Urinary losses of antithrombin III and plasminogen may contribute to impaired fibrinolysis. 4 , 5 Other cascade factors may also be increased synchronous with generalized compensatory hepatic protein synthesis. Serum d -dimer, for example, a marker of fibrin turnover, appears to be mildly raised in NS, independent of glomerular filtration rate (GFR) and in the absence of clinical evidence of thrombosis.…”

“…The risk of arterial events in NS appears to be more variable than venous thrombosis, 5 and are thought to be related to platelet aggregation, which could be related to urinary loss of inhibitory substances (such as plasminogen) and compounded by age, diabetes, previous arterial events, and corticosteroid use. 32 A recent review of the literature on arterial thrombosis, particularly stroke in NS, raises the possibility that arterial events in NS have a different inciting pathophysiology from that of venous events.…”

“… 32 A recent review of the literature on arterial thrombosis, particularly stroke in NS, raises the possibility that arterial events in NS have a different inciting pathophysiology from that of venous events. 5 Traditional risk factors for arterial events, particularly smoking, appear to be important. 5 …”