Pulmonary thrombo-embolism in nephrotic syndrome treated with tissue plasminogen activator

Reid, Christopher; Segal, Terry

doi:10.1007/s004310050684

Cited by 8 publications

(5 citation statements)

References 13 publications

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“…Earlier case reports of PTE have described intensive and invasive therapy like intrapulmonary streptokinase and tissue plasminogen activator for treatment [8,10]. Major pulmonary arteries were not involved in both our patients.…”

Section: Discussioncontrasting

confidence: 52%

“…Autopsy revealed pulmonary vessels containing a saddle embolus and diffuse well-organised clots throughout the majority of pulmonary vessels, highlighting the fatal consequences of PTE. Another report [10] highlights the minor respiratory symptoms in a boy with steroid-sensitive nephrotic syndrome with pulmonary thrombo-embolism, who recovered after an infusion of tissue plasminogen activator into the pulmonary artery.…”

Section: Discussionmentioning

confidence: 96%

“…Hence, further investigations may be required. Many of the case reports describing pulmonary thrombotic/thromboembolic events in nephrotic syndrome have used angiography for diagnosis [8,10]. But this is an invasive investigation.…”

Section: Discussionmentioning

confidence: 96%

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Pulmonary thrombosis in steroid-sensitive nephrotic syndrome

Deshpande

Griffiths²

2005

Pediatr Nephrol

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Thrombo-embolic episodes are an uncommon but known complication of nephrotic syndrome. However, pulmonary thrombosis/thromboembolism is rare, especially in children. We describe the cases of two girls, aged 12 years, who presented with severe oedema in relapse. They had intermittent tachypnoea, and CT pulmonary angiography (CTPA) provided a less invasive and more definitive way of confirming pulmonary thrombosis/thromboembolism. They received heparin with resolution of the tachypnoea. Anticoagulation was continued for 6 months after the episode in one patient. They have been in remission for more than 1 year, and a thrombophilia screen does not indicate a predisposing tendency to the formation of clots. Pulmonary thrombosis/thromboembolism could present with subtle symptoms and needs prompt diagnosis and treatment to prevent a fatal outcome.

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Section: Discussioncontrasting

confidence: 52%

Section: Discussionmentioning

confidence: 96%

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Pulmonary thrombosis in steroid-sensitive nephrotic syndrome

Deshpande

Griffiths²

2005

Pediatr Nephrol

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“…A recent trial involving 30 neonates treated with LMWH found a poor therapeutic response to recommended doses based on measured anti-Xa levels, and the authors suggest higher initial doses may be required to achieve therapeutic anticoagulation [ 124 ]. No robust data on the safety and efficacy of thrombolytic therapy in children with INS exist, but effective and safe use of streptokinase [ 96 , 125 ] and tissue plasminogen activator [ 126 ] for severe TED has been documented in children with INS.…”

Section: Thromboembolic Diseasementioning

confidence: 99%

The non-immunosuppressive management of childhood nephrotic syndrome

2015

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Idiopathic nephrotic syndrome (INS) is one of the most common renal diseases found in the paediatric population and is associated with significant complications, including infection and thrombosis. A high proportion of children enter sustained remission before adulthood, and therapy must therefore mitigate the childhood complications, while minimising the long-term risk to health. Here we address the main complications of INS and summarise the available evidence and guidance to aid the clinician in determining the appropriate treatment for children with INS under their care. Additionally, we highlight areas where no consensus regarding appropriate management has been reached. In this review, we detail the reasons why routine prophylactic antimicrobial and antithrombotic therapy are not warranted in INS and emphasise the conservative management of oedema. When pharmacological intervention is required for the treatment of oedema, we provide guidance to aid the clinician in determining the appropriate therapy. Additionally, we discuss obesity and growth, fracture risk, dyslipidaemia and thyroid dysfunction associated with INS. Where appropriate, we describe how recent developments in research have identified potential novel therapeutic targets.

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“…Although PTE in children is probably more frequent than is currently realized, reports on thrombolytic therapy are relatively uncommon. Excluding cases associated with cardiac surgery, we have identified only three reports in the literature over the last 10 years, all of which occurred in children with nephrotic syndrome (Reid & Segal, 1997; Share et al , 1996; Jones & Hebert, 1991). Two were treated with SK and one with t‐PA, in each case treatment was administered locally via the pulmonary artery and resulted in a favourable outcome.…”

Section: Specific Indications For Thrombolysismentioning

confidence: 99%