Fraisse C, Nouvier M, Lainez S, Nesme P, Ernesto S, Devouassoux G
Service de pneumologie, bâtiment I, hôpital de la Croix-Rousse, groupement hospitalier nord, hospices civils de Lyon et université Claude-Bernard Lyon 1, 103, grande-rue de la Croix-Rousse, 69317 Lyon cedex 04, France.
Service de néphrologie hôpital Lyon sud, groupement hospitalier sud, hospices civils de Lyon et université Claude-Bernard Lyon 1, France.
Rev Mal Respir. 2017 Sep;34(7):765-769. doi: 10.1016/j.rmr.2016.12.002. Epub 2017 Aug 25.
Nephrotic syndrome (NS) in adults is defined by proteinuria>3g/24h or 50mg/kg/d, hypoproteinemia<60g/24h and hypoalbuminemia<30g/L. The final diagnosis is guided by the histopathology evidence when a renal biopsy is possible. The consequences of NS are multiple: high blood pressure, undernutrition, infections and a hypercoagulable state.
We report the case of a patient presenting with thromboembolic disease, occurring in the absence of other thromboembolic risk factors, which revealed NS with spontaneously favorable evolution.
Thromboembolic disease in NS is frequent but underestimated and may remain underdiagnosed. Thorough investigation - including serum protein levels and testing for proteinuria - are essential in thromboembolism, as is excluding cancer or another cause. The treatment of thromboembolic disease in NS is based on anticoagulation for as long as the NS persists. There is no consensus about primary prophylaxis but an albumin level below 20g/L should be considered as a risk factor of thrombosis and prophylactic anticoagulation should be started.
成人肾病综合征（NS）的定义为蛋白尿>3g/24小时或50mg/（kg·d）、低蛋白血症<60g/24小时以及血清白蛋白血症<30g/L。若可行肾活检，则最终诊断以组织病理学证据为指导。NS的后果多种多样：高血压、营养不良、感染以及高凝状态。
我们报告了1例患者，其出现血栓栓塞性疾病，在无其他血栓栓塞危险因素的情况下，经检查发现为NS，且病情自发好转。
NS中的血栓栓塞性疾病很常见，但常被低估，可能仍未得到充分诊断。在血栓栓塞症中，全面检查（包括血清蛋白水平和蛋白尿检测）至关重要，排除癌症或其他病因也同样重要。NS中血栓栓塞性疾病的治疗基于在NS持续期间进行抗凝治疗。对于一级预防尚无共识，但血清白蛋白水平低于20g/L应被视为血栓形成的危险因素，应开始预防性抗凝治疗。
