Kayali Fadi, Najjar Reiad, Aswad Firas, Matta Fadi, Stein Paul D
St. Joseph Mercy Oakland Hospital, Pontiac, MI 48341-5023, USA.
Am J Med. 2008 Mar;121(3):226-30. doi: 10.1016/j.amjmed.2007.08.042.
Whether pulmonary embolism in patients with the nephrotic syndrome is caused by deep venous thrombosis or renal vein thrombosis is controversial. To determine which is the likely cause of pulmonary embolism in patients with the nephrotic syndrome, we investigated data from the National Hospital Discharge Survey.
The number of patients discharged from nonfederal short-stay hospitals in the United States with a diagnostic code of nephrotic syndrome, deep venous thrombosis, renal vein thrombosis, and pulmonary embolism was obtained using ICD-9-M (International Classification of Diseases, Ninth Revision, Clinical Modification) codes.
From 1979 to 2005, 925,000 patients were discharged from hospitals with the nephrotic syndrome and 898,253,000 patients did not have the nephrotic syndrome. With the nephrotic syndrome, 5000 (0.5%) had pulmonary embolism, 14,000 (1.5%) had deep venous thrombosis, and fewer than 5000 had renal vein thrombosis. The relative risk of pulmonary embolism comparing patients with the nephrotic syndrome to those who did not have it was 1.39, and the relative risk of deep venous thrombosis was 1.72. Among patients aged 18-39 years, the relative risk of deep venous thrombosis was 6.81. From 1991-2005, after venous ultrasound was generally available, the relative risk of deep venous thrombosis (all ages) was 1.77.
The nephrotic syndrome is a risk factor for venous thromboembolism. This is strikingly apparent in young adults. Renal vein thrombosis was uncommon. Therefore, pulmonary embolism, if it occurs, is likely to be due to deep venous thrombosis and not renal vein thrombosis.
肾病综合征患者的肺栓塞是由深静脉血栓形成还是肾静脉血栓形成引起存在争议。为了确定肾病综合征患者肺栓塞的可能病因，我们调查了国家医院出院调查的数据。
使用国际疾病分类第九版临床修订本（ICD - 9 - M）编码，获取美国非联邦短期住院医院出院的诊断为肾病综合征、深静脉血栓形成、肾静脉血栓形成和肺栓塞的患者数量。
1979年至2005年，925,000例患者因肾病综合征出院，898,253,000例患者无肾病综合征。患有肾病综合征的患者中，5000例（0.5%）发生肺栓塞，14,000例（1.5%）发生深静脉血栓形成，肾静脉血栓形成患者少于5000例。肾病综合征患者与非肾病综合征患者相比，肺栓塞的相对风险为1.39，深静脉血栓形成的相对风险为1.72。在18 - 39岁的患者中，深静脉血栓形成的相对风险为6.81。1991年至2005年，静脉超声普遍可用后，深静脉血栓形成（所有年龄段）的相对风险为1.77。
肾病综合征是静脉血栓栓塞的危险因素。这在年轻成年人中尤为明显。肾静脉血栓形成并不常见。因此，如果发生肺栓塞，可能是由于深静脉血栓形成而非肾静脉血栓形成。
