Deep venous thrombosis in a child with nephrotic syndrome – case report

Česká verzia

Authors: Ľ. Kováčiková ml. ¹; M. Chocholová ¹; M. Ondriska ²; Ľ. Podracká ¹
Authors place of work: 1. detská klinika LFUK a DFNsP, Bratislava prednostka prof. MUDr. Ľ. Podracká, CSc. ¹; Rádiologické oddelenie DFNsP, Bratislava vedúci prim. MUDr. D. Haviar ²
Published in the journal: Čes-slov Pediat 2016; 71 (2): 91-95.
Category: Case Report

Summary

Deep venous thrombosis in a child with nephrotic syndrome – case report

In children with nephrotic syndrome thrombosis is well known and formidable complication with incidence of 2 to 9%. Nephrotic syndrome is associated with acquired hypercoagulation status. Etiology is multifactorial. Thrombogenic milieu is a result of urinary loss (antithrombin III, protein S) and increased synthesis of procoagulation factors (fibrinogen, V and VIII factors). Impaired fibrinolysis, hemoconcentration, patient immobility especially in association with anasarca, infection and central venous catheter are further contributing factors. Deep venous thrombosis can occur at venous or arterial system, most frequently in lower limb deep veins, renal veins, pulmonary circulation. Less frequently, thrombosis is located in other areas of vascular system. Anticoagulation therapy is indicated according to severity of thrombotic complication. Prophylaxis is recommended only in children with high risk for thrombosis.

Authors present a rare case of familiar, primary corticoresistant nephrotic syndrome complicated with extensive deep venous thrombosis in an toddler.

Key words:
nephrotic syndrome in children, deep venous thrombosis, anticoagulation therapy

Zdroje

1. Kerlin BA, Ayoob R, Smoyer W. Epidemiology and pathophysiology of nephrotic syndrome-associated thrombembolic disease. Clin J Am Soc Nephrol 2012; 7: 513–520.

2. Geier P, Feber J. Léčba steroid-senzitivního nefrotického syndromu u dětí. Pediatr praxi 2010; 11: 245–247.

3. Niaudet P. Complication of nephrotic syndrome in children. UpToDate, 2015.

4. Dickinson WH. On Renal and Urinary Afections. New York: William Wood &Company, 1885: 32.

5. Vondrák V, Skálová S, Šulíková T, et al. Nefrotický syndrom. In: Janda J, Seeman T. Dětská nefrologie. Praha: Mladá fronta – Medical Services, 2015: 294–307.

6. Kendall AG, Lohman RC, Dossetor JB. Nephrotic syndrome: a hypercoagulable state. Arch Intern Meed 1971; 127: 1021–1027.

7. Hoyer PF, Gonda S, Bartheis M, et al. Thrombembolic complications in children with nephrotic syndrome. Risk and incidence. Acta Paediatr Scand 1986; 75: 804.

8. Candelaria GTP, Belangero VMS. Predisposing factors for deep venous thrombosis in children and adolescents with nephrotic syndrome. ISRN Vascular Medicine 2011; Article ID 827483: 1–5.

9. Kerlin BA, Blatt NB, Fuh B, et al. Epidemiology and risk factors for thromboembolic complications of childhood nephrotic syndrome: a Midwest Pediatric Nephrology Consortium (MWPNC) study. J Pediatr 2009; 155: 105–110.

10. Derrow HA, Schlesinger MJ, Savitz HA. Chronic progressive occlusion of the inferior vena cava and the renal and portal veins. Arch Intern Med 1939; 63: 626–647.

11. Loscalzo J. Venous thrombosis in the nephrotic syndrome. N Engl J Med 2013; 368: 956–958.

12. Torres RA, Torres BR, de Castilho AS, et al. Venous sinus thrombosis in a child with nephrotic syndrome: a case report and literature review. Rev Bras Ter Intensiva 2014; 26: 430–434.

13. Suri D, Ahluwalia J, Saxena AK, et al. Tromboembolic complications in childhood nephrotic syndrome: a clinical profile. Clin Exp Nephrol 2014; 18: 803–813.

14. Fencl F, Stará V, Bláhová K, et al. Masivní plicní embolie jako první příznak nefrotického syndromu u 18leté pacientky. Čes-slov Pediat 2013; 68: 43–48.

15. Citak A, Emre S, Sâirin A, et al. Hemostatic problems and thromboembolic complications in nephrotic children. Pediatr Nephrol 2000; 14: 138–142.

16. Vaisbich MH. Síndrome Nefrótica. 1st ed. Barueri, Brazil: Manole, 2009: 573–589.

17. Lilova MI, Velkovski IG, Topalov IB. Thromboembolic complications in children with nephrotic syndrome in Bulgaria (1974–1996). Pediatr Nephrol 2000; 15: 74–78.

18. Fabri D, Belangero VM, Annichino-Bizzacchi JM, et al. Inherited risk factors for thrombophilia in children with nephrotic syndrome. Eur J Pediatr 1998; 157: 939–942.

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

20. Glassock RJ. Prophylactic anticoagulation in nephrotic syndrome: a clinical conundrum. J Am Soc Nephrol 2007; 18: 2221–2225.