Renal vein thrombosis in idiopathic membranous glomerulopathy and nephrotic syndrome: Incidence and significance

Wagoner, Richard D.; Stanson, Anthony W.; Holley, Keith E.; Winter, Christine S.

doi:10.1038/ki.1983.28

Cited by 124 publications

(83 citation statements)

References 22 publications

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“…Deep vein thrombosis, especially renal vein thrombosis, is reported to occur more frequently among patients with membranous nephropathy (MN) than other nephrotic diseases (2)(3)(4)(5)(6)(7)(8)(9). Given the impact of thrombotic events on morbidity and mortality of patients with nephrotic syndrome, the question of prophylactic anticoagulation presents an important clinical dilemma for which no evidence-based guidelines are available.…”

Section: Introductionmentioning

confidence: 99%

Venous Thromboembolism in Patients with Membranous Nephropathy

Lionaki¹,

Derebail²,

Hogan³

et al. 2012

Clinical Journal of the American Society of Nephrology

188

148

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SummaryBackground and objectives The aims of this study were to determine the frequency of venous thromboembolic events in a large cohort of patients with idiopathic membranous nephropathy and to identify predisposing risk factors.Design, setting, participants, & measurements We studied patients with biopsy-proven membranous nephropathy from the Glomerular Disease Collaborative Network (n=412) and the Toronto Glomerulonephritis Registry (n=486) inception cohorts. The cohorts were pooled after establishing similar baseline characteristics (total n=898). Clinically apparent and radiologically confirmed venous thromboembolic events were identified. Potential risk factors were evaluated using multivariable logistic regression models.Results Sixty-five (7.2%) subjects had at least one venous thromboembolic event, and this rate did not differ significantly between registries. Most venous thromboembolic events occurred within 2 years of first clinical assessment (median time to VTE = 3.8 months). After adjusting for age, sex, proteinuria, and immunosuppressive therapy, hypoalbuminemia at diagnosis was the only independent predictor of a venous thromboembolic event. Each 1.0 g/dl reduction in serum albumin was associated with a 2.13-fold increased risk of VTE. An albumin level ,2.8 g/dl was the threshold below which risk for a venous thromboembolic event was greatest.Conclusions We conclude that clinically apparent venous thromboembolic events occur in about 7% of patients with membranous nephropathy. Hypoalbuminemia, particularly ,2.8 g/dl, is the most significant independent predictor of venous thrombotic risk.

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Section: Introductionmentioning

confidence: 99%

Venous Thromboembolism in Patients with Membranous Nephropathy

Lionaki¹,

Derebail²,

Hogan³

et al. 2012

Clinical Journal of the American Society of Nephrology

188

148

View full text Add to dashboard Cite

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“…Pulmonary embolism and renal vein thrombosis are most grave complications of nephrotic syndrome. [1][2][3][4][5][6] Thromboembolic disease is an important complication in childhood Nephrotic Syndrome (NS) affecting about 5% of patients. 7 A 19% incidence of abnormal ventilation/perfusion scans found in adult nephrotic syndrome patients without any clinical evidence of pulmonary thrombosis, suggest that the real incidence of thromboembolism in nephrotic syndrome may even be higher.…”

Section: Introductionmentioning

confidence: 99%

A study of PT, APTT, fibrinogen and urinary protein-creatinine ratio in paediatric patients with nephrotic syndrome

Rani

2014

Int J Contemp Pediatr

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“…Because of its frequency, it remains the second or third cause of a primary glomerulopathy leading to ESRD (29). Patients with MN who remain nephrotic are at an increased risk for thromboembolic (30) and cardiovascular (31,32) events. Available immunosuppressive therapies include the use of corticosteroids combined with cytotoxic agents, as well as calcineurin inhibitors.…”

Section: Discussion Of Questionmentioning

confidence: 99%

American Society of Nephrology Quiz and Questionnaire 2012

Fervenza

Glassock

Bleyer

2013

Clinical Journal of the American Society of Nephrology

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SummaryPresentation of the Nephrology Quiz and Questionnaire (NQQ) has become an annual tradition at the meetings of the American Society of Nephrology. It is a very popular session, judged by consistently large attendance. Members of the audience test their knowledge and judgment on a series of case-oriented questions prepared and discussed by experts. They can also compare their answers in real time, using audience response devices, to those of program directors of nephrology training programs in the United States, acquired through an Internet-based questionnaire. The topic presented here is GN. Cases representing this category, along with single best answer questions, were prepared by a panel of experts (Drs. Fervenza, Glassock, and Bleyer). The correct and incorrect answers were then briefly discussed after the audience responses and the results of the questionnaire were displayed. This article recapitulates the session and reproduces its educational value for a larger audience-that of the readers of the Clinical Journal of the American Society of Nephrology. Have fun.Clin J Am Soc Nephrol 8: 1460-1465, 2013. doi: 10.2215/CJN.00440113 GN Case 1A 20-year-old woman was referred for evaluation of persistent hematuria and proteinuria. She had a history of fever and sore throat lasting 1 week that occurred 6 months earlier and were associated with abdominal pain and dark urine. She did not receive any antimicrobial agents. Significant findings on physical examination at that time included a BP of 140/90 mmHg and 2+ edema. Laboratory evaluation showed a serum creatinine value of 1.4 mg/dl, urinalysis with 2+ protein and 3+ blood, and a 24-hour urinary protein excretion of 680 mg. The C3 level was 46 mg/dl (reference range, 75-175 mg/dl) and the C4 level was 23 mg/dl (reference range, 14-40 mg/dl). A throat culture was negative for b-hemolytic streptococci, and an antistreptolysin O titer was 200 IU/ml (upper limit of normal, 200 IU/ml). The serum albumin concentration was 3.6 g/dl.A renal biopsy was performed and showed a pattern of membranoproliferative GN on light microscopy. No crescents were observed. Immunofluorescence microscopy showed bright (3+) mesangial and capillary wall C3 staining. Electron microscopy showed mesangial, intramembranous, and subendothelial deposits, as well as a few subepithelial hump-like deposits. Postinfectious GN and type III membranoproliferative GN were diagnosed. The patient was treated symptomatically, but proteinuria and hematuria persisted. Current evaluation shows a hemoglobin level of 11.8 g/dl, a serum creatinine concentration of 1.3 mg/dl, urinalysis with 3+ blood and 3+ protein, quantitative proteinuria of 2.2 g/24 hours, C3 concentration of 44 mg/dl, and C4 concentration of 22 mg/dl. Question 1 (see Figure 1 for responses of program directors and attendees)To further evaluate this patient, you would now order:A. Antinuclear antibodies B. Hepatitis B and C serology C. Anti-deoxyribonuclease (DNase) antibody titers D. Serum C1q level E. Antibodies to complement-regulating ...

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Renal vein thrombosis in idiopathic membranous glomerulopathy and nephrotic syndrome: Incidence and significance

Cited by 124 publications

References 22 publications

Venous Thromboembolism in Patients with Membranous Nephropathy

Venous Thromboembolism in Patients with Membranous Nephropathy

A study of PT, APTT, fibrinogen and urinary protein-creatinine ratio in paediatric patients with nephrotic syndrome

American Society of Nephrology Quiz and Questionnaire 2012

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