Venous sinus thrombosis in a child with nephrotic syndrome: a case report and literature review

Abstract

Nephrotic syndrome is associated with a hypercoagulable state and an increased risk of thromboembolic complications. Cerebral venous sinus thrombosis is a rare complication of nephrotic syndrome, with few cases described in the literature, although the disease may be under-diagnosis. The true incidence of cerebral venous sinus thrombosis may be underestimated because many events are asymptomatic or are not diagnosed in time. Here, we describe the case of a male child, 2 years and 10 months old, with nephrotic syndrome presenting with headache, epileptic seizures and sensory inhibition who was diagnosed with superior sagittal and transverse sinuses thrombosis. An international literature review was performed with a defined search strategy in the PubMed, SciELO and Lilacs databases using the terms ‘nephrotic syndrome’ and ‘cerebral sinovenous thrombosis’. The diagnosis of venous thrombosis should be considered in any patient with nephrotic syndrome who presents with neurological signs and symptoms, as early clinical diagnosis promotes favorable outcomes.

Nephrotic Syndrome May Be One of the Important Etiologies of Cerebral Venous Sinus Thrombosis

“…1 Xu et al 9 reported that CVST occurs most typically in the 20-to 45-year-old male patients with initial onset of NS or poorly controlled nephrosis due to the massive loss of endogenous antithrombotic factors and acute hypovolemia during these periods of the disease. 27 The superficial venous system is involved more commonly than the deep venous system, and the commonest site of CVST is the superior sagittal sinus, followed by transversal, sigmoid, and straight sinuses, 28 but in two thirds of the cases more than 1 sinus is involved. 29 Imaging examination such as plain CT or MRI, which has less impact on renal function, should be used as the initial evaluation of NS patients with suspected CVST.…”

Cavernous sinus thrombosis in a patient with nephrotic syndrome

“…Women also have a better prognosis [9]. While there have been reports of CVT in nephrotic syndrome [11,12], cavernous sinus thrombosis is nearly always caused by an infection of the paranasal sinuses, the orbit, or the face [13]. This is the first report of a nephrotic syndrome-related cavernous sinus thrombosis, but it is difficult to exclude the possibility that the dental treatment at the beginning of the case was partly responsible for the subsequent cavernous sinus thrombosis.…”

Thromboembolic complications at the onset of nephrotic syndrome

“…The incidence of thromboembolic complications in nephrotic children varies between 2% to 5% with a higher incidence in SRNS than steroid responsive NS [3]. Sino-venous thrombosis is probably less recognized or under-reported in children with nephrotic syndrome [4].…”