Department of Internal Medicine, University Hospital of Lausanne and University of Lausanne (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
Service of Nephrology, Riviera-Chablais Hospital, Rennaz, Switzerland.
J Med Case Rep. 2021 Nov 25;15(1):569. doi: 10.1186/s13256-021-03132-6.
Nephrotic-range proteinuria is a common reason for nephrological consultation in clinical practice. The differential diagnosis is wide, and generally focuses on different forms of glomerulonephritis, but other causes should not be overlooked, as illustrated in this article.
We report two female patients with nephrotic-range proteinuria. In the first case, a 46 year old Caucasian patient who suffered from extreme obesity (Body mass index (BMI) 77 kg/m), acute kidney injury and nephrotic-range proteinuria were discovered during an emergency consultation for acute abdominal pain. The second patient (aged 52, also Caucasian) developed stage 4 chronic kidney disease and nephrotic proteinuria (protein/creatinine ratio 1821 g/mol) after accidental rupture of the inferior vena cava during a gastric bypass operation. On split-urine collection, both had a much higher degree of proteinuria during the day than during the night, compatible with orthostatic proteinuria. At further work-up, inferior vena cava thrombosis was diagnosed in both patients, whereas renal veins were patent.
After simple anticoagulation in the first case, and anticoagulation plus endovascular recanalization in the second, there was almost complete resolution of the orthostatic proteinuria and a strong improvement of the estimated glomerular filtration rate in both patients. These cases highlight that nephrotic-range proteinuria can be linked to inferior vena cava thrombosis, and that a split-urine collection may also be very useful in the diagnostic work-up of proteinuria in adults.
肾病范围蛋白尿是临床实践中肾脏科会诊的常见原因。鉴别诊断范围广泛，通常侧重于不同形式的肾小球肾炎，但不应忽视其他原因，本文对此进行了说明。
我们报告了两名肾病范围蛋白尿的女性患者。在第一个病例中，一名 46 岁的白人女性患者因极度肥胖（体重指数（BMI）为 77kg/m）、急性肾损伤和肾病范围蛋白尿在因急性腹痛就诊时被发现。第二位患者（52 岁，也是白人）在胃旁路手术后下腔静脉意外破裂后发展为 4 期慢性肾脏病和肾病范围蛋白尿（蛋白/肌酐比值为 1821g/mol）。在分尿收集时，两名患者白天的蛋白尿程度均明显高于夜间，符合直立性蛋白尿。进一步检查后，两名患者均被诊断为下腔静脉血栓形成，而肾静脉通畅。
在第一个病例中，简单抗凝治疗后，第二个病例中抗凝联合血管内再通治疗后，两名患者的直立性蛋白尿几乎完全缓解，估计肾小球滤过率明显改善。这些病例提示肾病范围蛋白尿可能与下腔静脉血栓形成有关，分尿收集也可能对成人蛋白尿的诊断有很大帮助。
