The Nephrotic Syndrome: An Unusual Case of Multiple Embolic Events

Abstract

The nephrotic syndrome is an unusual cause of the hypercoaguable state and thromboembolic complications. Here we report the case of a 42-year-old woman with nephrotic syndrome who presented with a pulseless lower extremity and a midpole renal infarct requiring urgent embolectomy of the leg. During her embolic evaluation, she was found to have an intracardiac thrombus. Over the course of her hospitalization, she developed a pulseless upper extremity and required an embolectomy of her arm. We believe that this represents the first case report of a patient with nephrotic syndrome, intracardiac thrombus, and evidence of embolization to 3 sites: kidney, arm, and leg.

Keywords

nephrotic syndrome hypercoaguable thromboembolism

Get full access to this article

View all access options for this article.

References

Singhal R. , Brimble KS Thromboembolic complications in the nephrotic syndrome: pathophysiology and clinical management. Thromb Res. 2006;118:397-407.

Tarry WC , Moser AJ , Makhoul RG Peripheral arterial thrombosis in the nephrotic syndrome. Surgery. 1993;114:618-623.

Huang TY , Chau KM Biventricular thrombi in diabetic nephrotic syndrome complicated by cerebral embolism. Int J Cardiol. 1995;50:193-196.

Malik GH , Al-Wakeel JS , Al- Mohaya A. , Wasfy I. , Kechrid MS , El-Gamal HH Intraventricular and brachial artery thrombosis in nephrotic syndrome . Am J Nephrol. 1998;18:142-145.

Mak SK , Wong PN , Lee KF , Fung LH , Wong AKM. Intracardiac thrombus in an adult patient with nephrotic syndrome . Nephrol Dial Transplant. 1996;11: 1627-1630.

Weisz W. , Kemper MJ , Weil J. , Muller-Wiefel DE Asymptomatic intracardiac thrombus in steroid sensitive nephrotic syndrome . Pediatr Nephrol. 2002;17:287-289.

Raj M. , Ramakrishnan A. , Shenoy P. , Negi CS , Swaminathan RP Asymptomatic right atrial thrombus in a case of nephrotic syndrome . J Nephrol. 2006;19: 825-827.

Mortazavi F. , Samadi M. Asymptomatic intracardiac thrombus in a child with nephrotic syndrome. Arch Iran Med. 2006 ;9:426-428.

Aoyagi S. , Kashikie H. , Kawara T. , Ikeda S. Left atrial thrombus without mitral valve disease in a patient with nephrotic syndrome: report of a case. Surg Today. 2002 ;32:992-995.

10.

Lonsdale RJ , Berridge DC , Makin GS , Hopkinson BR , Wenham PW Detection of left heart thrombus by echocardiography is not essential before peripheral arterial thrombolysis. J R Coll Surg of Edinb. 1992 ;37: 19-22.

11.

Gomez-Beldarrain M. , Telleria M. , Garcia-Monco JC Peripheral arterial embolism during thrombolysis for stroke. Neurology. 2006;67:1096-1097.

12.

Keren A. , Goldberg S. , Gottlieb S. , et al. Natural history of left ventricular thrombi: their appearance and resolution in the posthospitalization period of acute myocardial infarction . J Am Coll Cardiol. 1990;15:790-800.

13.

Kremer P. , Fiebig R. , Tilsner V. , Bleifield W. , Mathey DG Lysis of left ventricular thrombi with urokinase. Circulation . 1985;72:112-118.

14.

Tong AT , Roudat R. , Ozkan M. , et al. Transesophageal echocardiography improves risk assessment of thrombolysis of prosthetic valve thrombosis: results of the international PRO-TEE registry. J Am Coll Cardiol. 2004;7:77-84.

15.

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