Hârza M, Ismail G, Mitroi G, Gherghiceanu Mihaela, Preda A, Mircescu G, Sinescu I
Department of Nephrology, Urology, Transplant Immunology, Dermatology and Allergology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania;
Rom J Morphol Embryol. 2013;54(3):555-60.
The risk of thromboembolic events is increased in patients with nephrotic syndrome (NS) as compared with other medical conditions and is a severe complication associated with significant morbidity and mortality. We aimed to assess the risk of renal vein thrombosis, and other venous thromboembolic events (VTE) in a large cohort of patients with NS and to identify the disease-specific risk for VTE.
We performed a prospective observational study including consecutive adult patients with primitive NS admitted to our department. Clinical and biological data were obtained every six months during follow-up. Occurrence of VTE confirmed by imaging techniques was the primary study outcome.
We enrolled 191 patients (47±15 years, 53% men) with a median follow-up of 24 [IQR:12,36] months. During follow-up, 23 VTE occurred, of which 65.2% in the first six months. The disease-specific risk of VTE during the follow-up period was different across the histological groups, with the lowest risk in minimal change disease and IgA nephropathy and the highest in membranous nephropathy and membranoproliferative glomerulonephritis patients. In the subgroup of membranous, the severity of the subepithelial electron dense deposits did not correlate with the risk for VTE (p=0.5).
In this prospective study, the risk of VTE was higher in the first six months of follow-up in NS patients. The histological pattern seems to influence the risk of VTE in this setting.
与其他疾病相比，肾病综合征（NS）患者发生血栓栓塞事件的风险增加，且是一种与显著发病率和死亡率相关的严重并发症。我们旨在评估一大群NS患者发生肾静脉血栓形成及其他静脉血栓栓塞事件（VTE）的风险，并确定VTE的疾病特异性风险。
我们进行了一项前瞻性观察性研究，纳入了连续入住我科的原发性NS成年患者。随访期间每六个月获取临床和生物学数据。通过影像学技术确诊的VTE发生情况是主要研究结局。
我们纳入了191例患者（47±15岁，53%为男性），中位随访时间为24[四分位间距：12,36]个月。随访期间发生了23例VTE，其中65.2%发生在最初六个月。随访期间不同组织学组的VTE疾病特异性风险不同，微小病变型肾病和IgA肾病风险最低，膜性肾病和膜增生性肾小球肾炎患者风险最高。在膜性肾病亚组中，上皮下电子致密沉积物的严重程度与VTE风险无关（p=0.5）。
在这项前瞻性研究中，NS患者随访的前六个月VTE风险较高。在这种情况下，组织学模式似乎会影响VTE风险。
