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Thromboembolic complications in childhood nephrotic syndrome: a clinical profile

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Clinical and Experimental Nephrology Aims and scope Submit manuscript

Abstract

Background

Thromboembolism is a rare life-threatening complication of childhood nephrotic syndrome.

Methods

We present the clinical profile and outcome of 34 children with 35 events of thromboembolic complications with nephrotic syndrome.

Results

Cerebral venous thrombosis (CVT) was the commonest complication seen in 11 (31.4 %) children followed by pulmonary thromboembolism and deep venous thrombosis in 9 (25.7 %) and 6 (16.6 %) children, respectively. Arterial thrombosis resulting in central nervous system infarcts was observed in 7 (20 %) children and 2 children had thrombosis of the peripheral arteries. Episodes were equal in steroid-resistant nephrotic syndrome and steroid-dependent nephrotic syndrome groups. Most of the thromboembolic complications occurred with relapse but 11.4 % of children developed intracranial thrombosis during remission. The most sensitive symptom of CVT was persistent headache while unexplained respiratory distress and hypoxemia pointed towards pulmonary thromboembolism. Hypoalbuminemia was seen in 82.8 % of children, while concurrent infection was seen in 31.4 %. Coexistence of genetic prothrombotic condition was identified and merits evaluation. Early heparin therapy followed by oral anticoagulants resulted in complete recovery in 91.1 % of children. Death occurred in 3 (8.5 %) children and autopsy revealed pulmonary thromboembolism in 2 children.

Conclusion

Venous and arterial thrombotic complications can occur in children with nephrotic syndrome. A high index of suspicion is required as the clinical features may be subtle. Neuroimaging and angiographic techniques help in confirming diagnosis. Early aggressive heparin therapy followed by oral anticoagulants is necessary for a favorable outcome.

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References

  1. Niaudet P. Steroid resistant nephrotic syndrome. In: Niaudet P, Aver ED, Harmon WE, editors. Pediatric nephrology. Philadelphia: Lippincott Williams and Wilkins; 2004. p. 557–74.

    Google Scholar 

  2. Indian Pediatric Nephrology Group, Indian Academy of Pediatrics. Consensus statement on management of steroid sensitive nephrotic syndrome. Indian Pediatr. 2001;38:975–86.

    Google Scholar 

  3. Indian Pediatric Nephrology Group, Indian Academy of Pediatrics, Bagga A, Ali U, Banerjee S, Kanitkar M, Phadke KD, Senguttuvan P, et al. Management of steroid sensitive nephrotic syndrome: revised guidelines. Indian Pediatr. 2008;45:203–14.

    PubMed  Google Scholar 

  4. Indian Society of Pediatric Nephrology, Gulati A, Bagga A, Gulati S, Mehta KP, Vijayakumar M. Management of steroid resistant nephrotic syndrome. Indian Pediatr. 2009;46:35–47.

    PubMed  Google Scholar 

  5. Suri D, Gupta N, Morigeri C, Saxena A, Manoj R. Chylopericardial tamponade secondary to superior vena cava thrombosis in a child with nephrotic syndrome. Pediatr Nephrol. 2009;24:1234–5.

    Article  Google Scholar 

  6. Hoyer PF, Gonda S, Barthels M, Krohn HP, Brodehl J. Thromboembolic complications in children with nephrotic syndrome. Risk and incidence. Acta Paediatr Scand. 1986;75:804–10.

    Article  PubMed  CAS  Google Scholar 

  7. Rabelink JT, Zwaginga JJ, Koomans HA, Sixma JJ. Thrombosis and hemostasis in renal disease. Kidney Int. 1994;46:287–96.

    Article  PubMed  CAS  Google Scholar 

  8. Tinaztepe K, Buyan N, Tinaztepe B, Akkok N. The association of nephrotic syndrome and renal vein thrombosis: a clinicopathological analysis of eight pediatric patients. Turk J Pediatr. 1989;31:1–18.

    PubMed  CAS  Google Scholar 

  9. Lilova MI, Velkovski IG, Topalov IB. Thromboembolic complications in children with nephrotic syndrome in Bulgaria (1974–1996). Pediatr Nephrol. 2000;15:74–8.

    Article  PubMed  CAS  Google Scholar 

  10. Andrew M, Brooker LA. Hemostatic complications in renal disorder of the young. Pediatr Nephrol. 1996;10:88–99.

    Article  PubMed  CAS  Google Scholar 

  11. Egli F, Eimiger P, Stalder G. Thromboembolism in the nephrotic syndrome (abstract). Pediatr Res. 1973;8:803.

    Google Scholar 

  12. Mehls O, Andrassay K, Koderisch J, Herzog U, Ritz E. Hemostasis and thromboembolism in children with nephrotic syndrome: differences from adult. J Pediatr. 1987;110:862–7.

    Article  PubMed  CAS  Google Scholar 

  13. Schlegel N. Thromboembolic risks and complications in nephrotic children. Semin Thromb Hemost. 1997;23:271–80.

    Article  PubMed  CAS  Google Scholar 

  14. Fabri D, Belangero VM, Annichino-Bizzacchi JM, Arruda VR. Inherited risk factors for thrombophilia in children with nephrotic syndrome. Eur J Pediatr. 1998;157:939–42.

    Article  PubMed  CAS  Google Scholar 

  15. Martinez Ara J, Gomez Rioja R, Rinon C, Garcia Munoz MS, Ruiz Caravaca ML, Miguel JL. Prevalence of genetic prothrombotic factors (factor V Leiden and II20210 prothrombin mutation) in glomerular nephropathies with or without thrombosis. Nefrologia. 2000;20:139–44.

    PubMed  CAS  Google Scholar 

  16. Schöning M, Klein R, Krägeloh-Mann I, Falck M, Bien S, Berg PA, et al. Antiphospholipid antibodies in cerebrovascular ischemia and stroke in childhood. Neuropediatrics. 1994;25(1):8–14.

    Article  PubMed  Google Scholar 

  17. Fluss J, Geary D, de Veber G. Cerebral sinovenous thrombosis and idiopathic nephrotic syndrome in childhood: report of four new cases and review of the literature. Eur J Pediatr. 2006;165:709–16.

    Article  PubMed  Google Scholar 

  18. Ishikura K, Ikeda M, Hamasaki Y, Hataya H, Nishimura G, Hiramoto R, Honda M. Nephrotic state as a risk factor for developing posterior reversible encephalopathy syndrome in paediatric patients with nephrotic syndrome. Nephrol Dial Transplant. 2008;23:2531–6.

    Article  PubMed  Google Scholar 

  19. Ishikura K, Ikeda M, Hamasaki Y, Hataya H, Shishido S, Asanuma H, Nishimura G, Hiramoto R, Honda M. Posterior reversible encephalopathy syndrome in children: its high prevalence and more extensive imaging findings. Am J Kidney Dis. 2006;48:231–8.

    Article  PubMed  Google Scholar 

  20. Huang J, Yang J, Ding J. Pulmonary embolism associated with nephrotic syndrome in children: a preliminary report of 8 cases. Chin Med J (Engl). 2000;113:251.

    CAS  Google Scholar 

  21. Deshpande PV, Griffiths M. Pulmonary thrombosis in steroid-sensitive nephrotic syndrome. Pediatr Nephrol. 2005;20:665–9.

    Article  PubMed  Google Scholar 

  22. Mittal BR, Singh S, Bhattacharya A, Prasad V, Singh B. Lung scintigraphy in the diagnosis and follow-up of pulmonary thromboembolism in children with nephrotic syndrome. J Clin Imaging. 2005;29:313–6.

    Article  Google Scholar 

  23. Stein PD, Gottschalk A, Sostman HD, Chenevert TL, Fowler SE, Goodman LR, et al. Methods of prospective investigation of pulmonary embolism diagnosis III (PIOPED III). Semin Nucl Med. 2008;38:462–70.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Witz M, Lehman J, Shnaker A, Korzets Z. Acute subclavian and brachial artery thrombosis as a complication of the nephrotic syndrome. Isr Med Assoc J. 2004;6:441–2.

    PubMed  Google Scholar 

  25. Siddiqi FA, Tepler J, Fantini GA. Acquired protein S and antithrombin III deficiency caused by nephrotic syndrome: an unusual cause of graft thrombosis. J Vasc Surg. 1997;25:576–80.

    Article  PubMed  CAS  Google Scholar 

  26. Hanna J, Truemper E, Burton E. Superior vena cava thrombosis and chylothorax: relationship in pediatric nephritic syndrome. Pediatr Nephrol. 1997;11:20–2.

    Article  PubMed  CAS  Google Scholar 

  27. Chugh KS, Malik N, Uberoi HS, Gupta VK, Aggarwal ML, Singhal PC, et al. Renal vein thrombosis in nephrotic syndrome—a prospective study and review. Postgrad Med J. 1981;57:566–70.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  28. Trew PA, Biava CG, Jacobs RP, Hopper J Jr. Renal vein thrombosis in membranous glomerulonephropathy: incidence and association. Medicine. 1978;57:69–82.

    Article  PubMed  CAS  Google Scholar 

  29. Velasquez Forero F, Garcia Prugue N, Ruiz Morales N. Idiopathic nephrotic syndrome of the adult with asymptomatic thrombosis of the renal vein. Am J Nephrol. 1988;8:457–62.

    Article  PubMed  CAS  Google Scholar 

  30. Wagoner RD, Stanson AW, Holley KE, Winter CS. Renal vein thrombosis in idiopathic membranous glomerulopathy and nephrotic syndrome: incidence and significance. Kidney Int. 1983;23:368–74.

    Article  PubMed  CAS  Google Scholar 

  31. Proceedings of the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy: evidence-based guidelines. Chest 2004;126:172S–696S.

    Google Scholar 

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Conflict of interest

All the authors have declared no competing interest.

Author information

Authors and Affiliations

  1. Division of Allergy Immunology and Nephrology, Department of Pediatrics, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Deepti Suri, Amit Rawat & Surjit Singh

  2. Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Jasmina Ahluwalia & Reena Das

  3. Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Akshay K. Saxena, Kushaljit S. Sodhi & Paramjeet Singh

  4. Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Bhagwant R. Mittal

Authors
  1. Deepti Suri
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  2. Jasmina Ahluwalia
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  3. Akshay K. Saxena
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  4. Kushaljit S. Sodhi
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  5. Paramjeet Singh
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  6. Bhagwant R. Mittal
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  7. Reena Das
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  8. Amit Rawat
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  9. Surjit Singh
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Correspondence to Deepti Suri.

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Suri, D., Ahluwalia, J., Saxena, A.K. et al. Thromboembolic complications in childhood nephrotic syndrome: a clinical profile. Clin Exp Nephrol 18, 803–813 (2014). https://doi.org/10.1007/s10157-013-0917-2

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  • DOI: https://doi.org/10.1007/s10157-013-0917-2

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