Chiang Wen-Fang, Chan Jenq-Shyong, Chu Pauling, Wu Chia-Chao
1 Attending Physician, Division of Nephrology, Department of Medicine, Armed Forces Taoyuan General Hospital, Taiwan.
2 Lecturer, Department of Medicine, College of Medicine, National Defense Medical Center, Taiwan.
Scott Med J. 2017 May;62(2):54-57. doi: 10.1177/0036933017695937. Epub 2017 Jan 1.
Introduction Pulmonary embolism is a potentially life-threatening complication of nephrotic syndrome. Syncope is rarely reported as an initial presentation of pulmonary embolism in nephrotic patients. Case presentation We describe a 35-year-old man who was taking steroids and diuretics for relapse of minimal change disease who presented after a syncopal event. The patient was hypotensive and had distended neck veins. The major laboratory findings were hypoalbuminemia with mild proteinuria. The findings on electrocardiography, chest radiography, and echocardiography and the elevated plasma D-dimer level raised suspicion of pulmonary embolism. Thrombi in the bilateral main pulmonary arteries on chest computed tomography together with compromised hemodynamics were consistent with the diagnosis of massive pulmonary embolism. He received anticoagulant treatment and the disease resolved. Conclusion Pulmonary embolism should be considered as a cause of syncope in patients with nephrotic syndrome, despite the absence of severe hypoalbuminemia and proteinuria, especially in patients taking concurrent steroid and diuretic therapy.
引言 肺栓塞是肾病综合征的一种潜在危及生命的并发症。在肾病患者中，晕厥作为肺栓塞的初始表现鲜有报道。病例报告 我们描述了一名35岁男性，因微小病变病复发正在服用类固醇和利尿剂，在一次晕厥事件后前来就诊。患者血压降低，颈静脉怒张。主要实验室检查结果为低白蛋白血症伴轻度蛋白尿。心电图、胸部X线和超声心动图检查结果以及血浆D-二聚体水平升高引发了对肺栓塞的怀疑。胸部计算机断层扫描显示双侧主肺动脉血栓形成，同时血流动力学受损，符合大面积肺栓塞的诊断。他接受了抗凝治疗，病情得以缓解。结论 对于肾病综合征患者，即使没有严重的低白蛋白血症和蛋白尿，尤其是正在同时服用类固醇和利尿剂的患者，也应考虑肺栓塞是晕厥的一个原因。
