Nephrotic Syndrome Complicated with Deep Venous Thrombosis in the Upper Extremities

Abstract

Deep venous thrombosis (DVT) in the upper extremities is a rare but important clinical illness, which leads to severe complications such as pulmonary embolism. Unlike DVT in the lower extremities, which is mainly induced by a hypercoagulable state, DVT in the upper extremities is usually caused by mechanical obstruction or anatomical stenosis in the venous system. We herein report a case in which DVT developed in the left upper limb during treatment of nephrotic syndrome. This is the first case report of upper-extremity DVT in association with nephrotic syndrome in the literature. Our patient was a 56-year-old male with nephrotic syndrome due to idiopathic membranous nephropathy who was treated with 40 mg/day of prednisolone. During corticosteroid therapy, he developed a swelling of the left upper limb. Computed tomography revealed thrombi in the left internal jugular vein and the left subclavian vein without anatomical abnormalities in his venous system. Thus, he was diagnosed with DVT of the upper extremities. After the initiation of warfarin treatment and subsequent regression of nephrotic syndrome, the swelling disappeared and the thrombi significantly diminished. DVT should be considered when upper-extremity edema is observed in patients with nephrotic syndrome.

Chronic thromboembolic pulmonary hypertension as the first manifestation of nephrotic syndrome in a 12-year-old child

“…Hypercoaguable states of blood is a well-known complication associated with NS. Venous thromboembolism, including deep venous thrombosis, renal vein thrombosis, pulmonary thrombosis and even internal jugular vein thrombosis, [ 4 , 10 , 11 ] can appear in course of the disease with the incidence as high as 25% to 40%. [ 12 ] Several mechanisms have been suggested for the development of thrombosis in NS, including imbalance between prothrombotic and antithrombotic factors, hyperviscosity and increased platelet aggregation.…”

Therapeutic Dilemmas regarding Anticoagulation: An Experience in a Patient with Nephrotic Syndrome, Pulmonary Embolism, and Traumatic Brain Injury

“…24,25 In the present patient, whether the original thrombus in the pulmonary arteries formed before or after the start of the initial heparinization as prophylactic anticoagulation remains unclear, although we believe that immobility due to bed rest during hospitalization, especially after the renal biopsy, might have predisposed our patient to the disease. 12,26 Considering the significant bleeding risk with renal biopsy, 27 no one would argue against our decision to stop the heparinization to facilitate the procedure. Instead, our policy may invite criticism because of the controversy regarding prophylactic anticoagulation among nephrotic patients with glomerulopathies other than membranous nephropathy.…”

Treatment of idiopathic internal jugular vein thrombosis in a healthy woman with enoxaparin and rivaroxiban: Case report and literature narrative review

“…All cases with a diagnosis of internal jugular vein thrombosis (with or without clinical signs), were included in this report [ [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] ]. We excluded cases if the abstracts had deficient clinical data.…”