Massive Pulmonary Embolism Occurring with Corticosteroid and Diuretics Therapy in a Minimal-Change Nephrotic Patient

Shimamatsu, Kazumasa; Onoyama, Kaoru; Maeda, Takeshi; Ohryoji, F.; Fujimi, Satoshi; Omae, T

doi:10.1159/000182809

Cited by 3 publications

(2 citation statements)

References 3 publications

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“…There have also been several reports of pulmonary thrombosis in NS patients. [4][5][6][7] Our patient experienced a fatal pulmonary thrombotic complication during anticoagulant therapy with intravenous heparin infusion. Intravenous heparin perfusion is widely performed, and it is a feasible therapy in patients with NS.…”

Section: Discussionmentioning

confidence: 84%

Fatal diffuse pulmonary arterial thrombosis as a complication of nephrotic syndrome

et al. 2007

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A 21-year-old man was admitted to our hospital because of leg edema. Because laboratory findings revealed massive proteinuria and hypoproteinemia, he was diagnosed as having nephritic syndrome caused by minimal change disease. He was given a continuous heparin infusion and intravenous steroid therapy, at a prednisolone dose of 1 mg/kg per day, and his condition gradually improved. Five months after discharge, the patient's proteinuria relapsed. He was readmitted to our hospital and we restarted anticoagulant treatment with intravenous heparin and 60 mg prednisolone. On the third hospital day, he complained of chest pain with sudden onset and dyspnea. He quickly developed shock and died. The findings of an autopsy confirmed the presence of diffuse fibrin thrombi in bilateral pulmonary arteries, and we diagnosed the cause of death as diffuse pulmonary artery thrombosis. A coagulation test for activated partial thromboplastin time (aPTT) had already shown that aPTT was prolonged before the initiation of treatment. There may have been a deficit of antithrombin III (ATIII) - a cofactor of heparin - because of the proteinuria; thus, the continuous heparin treatment might not have been effective for the prevention of thrombosis. Alternatives to heparin treatment that do not suppress AT III, such as nafamostat mesilate or argatroban, which do not require the presence of AT III for their anticoagulant action, should be considered in cases similar to the that in the patient reported here. In patients with nephrotic syndrome who exhibit altered coagulation test results, the choice of anticoagulation therapy for treatment of the hypercoagulabilty status associated with nephrotic syndrome should be carefully considered.

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Section: Discussionmentioning

confidence: 84%

Fatal diffuse pulmonary arterial thrombosis as a complication of nephrotic syndrome

et al. 2007

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“…Treatment with corticosteroids can increase the production of clotting factors, and the use of diuretics can cause hemoconcentration with a resultant increase in viscosity, which may thereby exacerbate the thromboembolic disturbance and lead to acute PE. 6 Of note, PE in nephrotic patients is frequently associated with concurrent use of steroids and diuretics. 7 Syncope can occur in nephrotic patients with acute PE, but this is rarely recognized.…”

Section: Discussionmentioning

confidence: 99%

Syncope in a patient with minimal change disease without nephrotic-range proteinuria

et al. 2017

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Introduction Pulmonary embolism is a potentially life-threatening complication of nephrotic syndrome. Syncope is rarely reported as an initial presentation of pulmonary embolism in nephrotic patients. Case presentation We describe a 35-year-old man who was taking steroids and diuretics for relapse of minimal change disease who presented after a syncopal event. The patient was hypotensive and had distended neck veins. The major laboratory findings were hypoalbuminemia with mild proteinuria. The findings on electrocardiography, chest radiography, and echocardiography and the elevated plasma D-dimer level raised suspicion of pulmonary embolism. Thrombi in the bilateral main pulmonary arteries on chest computed tomography together with compromised hemodynamics were consistent with the diagnosis of massive pulmonary embolism. He received anticoagulant treatment and the disease resolved. Conclusion Pulmonary embolism should be considered as a cause of syncope in patients with nephrotic syndrome, despite the absence of severe hypoalbuminemia and proteinuria, especially in patients taking concurrent steroid and diuretic therapy.

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Primary Glomerular Disease

Nachman¹,

Jennette²,

Falk³

2011

Brenner and Rector's the Kidney

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Massive Pulmonary Embolism Occurring with Corticosteroid and Diuretics Therapy in a Minimal-Change Nephrotic Patient

Cited by 3 publications

References 3 publications

Fatal diffuse pulmonary arterial thrombosis as a complication of nephrotic syndrome

Fatal diffuse pulmonary arterial thrombosis as a complication of nephrotic syndrome

Syncope in a patient with minimal change disease without nephrotic-range proteinuria

Primary Glomerular Disease

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