Clinical Analysis Of Nephrotic Syndrome With Thrombosis

Objective: Thromboembolism is a common and serious complication of nephroticsyndrome. However, because the majority of patients have no obvious symptoms ortypical symptoms, it’s difficult in early diagnosis. Besides, individualized treatmentprograms are indispensable. Both of them increase the difficulties in clinical work,having a direct impact on patients’ prognosis. In this paper, based on the analysis of10cases of nephrotic syndrome with thromboembolism, diagnosis and treatmentplans are probed, in order to be prompted for future clinical work.Materials and Methods：For10cases patients of nephrotic syndrome presenting withthromboembolism, demographic data is gathered，such as gender, age, medical history,family history of thromboembolism and so on. In addition, clinical information isinvestigated, including relevant information of nephrotic syndrome andthromboembolic events, laboratory parameters, imaging data. Statistical software isused for data processing and analysis.Result：(1) Of10patients,6patients are males and the others are females. One patienthas diabetes before NS. All the patients had no medical history of thrombosis andfamily history of embolism. Among the10patients, the range of age when they gotembolism is from20to62.2patients are younger than30years old. Within the agegroup30to40, there is one patient.3patients are within the age group40to50.4cases are over50years old. Two patients have the clear diagnosis of NS afterthrombotic events. When thromboembolic events diagnosed, nephrotic syndromeremains durations of16days to19months, the median duration is2months. Whileseven cases appeared thromboembolism before the use of hormone andimmunosuppressants, two appeared thromboembolism after the use of hormone forseveral days. The last one appeared thromboembolism after the use of hormone for2months.(2) The renal biopsy was conductd in seven patients, five cases weremembranous nephropathy, one case was focal proliferative glomerulonephritis, theother one was IgA nephropathy (Lee grade3).6cases were arterial thrombosis, including2cases of simple lower limb arterial thrombosis and4cases of cerebralembolism.2cases were venous thrombosis, both of which were pulmonary embolism.2patients had arterial thrombosis and venous thrombosis. The site of the occurrenceof thromboembolic: brain, lung, kidney, liver, spleen, etc.(3) About the six cases ofNS patients with cerebral infarction, a patient’s first symptom was headache. One caseinitially showed movement disorder of ipsilateral limb. One case’s initial symptomswere facial numbness and speech impairment. One case firstly showed sensorydysfunction and movement disorders.2cases initially appeared dyskinesia and speechdisorder. For the4cases of NS patients with PE, a patient had dyspnea, chest pain,cough and hemoptysis. The first symptoms of one patient were cough, chest pain anddyspnea. One patient had hemoptysis. A patient only had dyspnea.2cases of NS witharterial thrombosis in the lower limb appeared limb pain, coldness and paresthesia.(4)All patients had manifestations about nephrotic syndrome (proteinuria,hypoalbuminemia, hyperlipidemia, edema). Urine protein test were3+. An average ofalbumin was (20.13±4.36) g/L. Total cholesterol was7.65-18.66mmol/L, with amedian of12.13mmol/L. LDL was3.42-13.45mmol/L, with a median of6.53mmol/L.9patients underwent fibrinogen test, the value of fibrinogen in9patients were higherthan normal fibrinogen.7patients underwent D-dimer test,6patients were higher thannormal.(5) Two cases which had lower extremity arterial thrombus went into thedepartment of vascular surgery and had amputation. One case of cerebral infarctionwent into the department of neurosurgery for further treatment. A patient with cerebralinfarction transferred to a separate hospital. The remaining patients receivedanticoagulation and antiplatelet therapy after the diagnosis of thromboembolism. Twocases were also given short-term thrombolytic treatment. All patients’ symptoms wererelieved during the treatment.Conclusions:(1) In this paper it suggests that patients NS with cerebral infarction arecommonly in elderly age, while NS patients with other thromboembolism are muchyounger, especially NS with arterial thromboembolism.(2) Patients with nephroticsyndrome may have a higher incidence of thromboembolism within6months after the diagnosis of NS.(3) In this paper, of10NS patients membranous nephropathy (MN)may have a higher probability of thrombosis than other pathological types.