Department of Medicine, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India.
Department of Medicine, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
BMJ Case Rep. 2020 Dec 17;13(12):e237285. doi: 10.1136/bcr-2020-237285.
Renal biopsy is usually a prerequisite in the diagnosis of adult patients with nephrotic syndrome. Acute Budd Chiari syndrome is a known complication of certain aetiologies of nephrotic syndrome like membranous glomerulopathy and minimal change disease. This complication requires emergent anticoagulation, which would preclude the performance of a renal biopsy. We report the case of a 47-year-old woman who presented with acute Budd Chiari syndrome as the initial presentation of nephrotic syndrome. The difficult situation in which we had to give anticoagulation and also perform a renal biopsy led us to devise a novel way to treat the patient, namely, the initial use of transfemoral thrombolysis and thrombosuction followed by a renal biopsy, which confirmed the diagnosis of primary membranous nephropathy. Anticoagulation was safely instituted 48 hours later with documented clinical and radiological improvement.
肾活检通常是诊断成人肾病综合征的前提条件。急性巴德-吉亚里综合征是膜性肾小球病和微小病变性肾病等某些肾病综合征病因的已知并发症。这种并发症需要紧急抗凝，这将排除进行肾活检的可能性。我们报告了一例 47 岁女性，她以急性巴德-吉亚里综合征为首发表现的肾病综合征。在这种困难的情况下，我们必须给予抗凝治疗，同时进行肾活检，这促使我们设计了一种新的治疗方法，即首先使用经股动脉溶栓和血栓抽吸，然后进行肾活检，这证实了原发性膜性肾病的诊断。48 小时后安全地开始抗凝治疗，并记录到临床和影像学改善。
