Department of Internal Medicine, Mogadishu Somali Turkey, Training and Research Hospital, Mogadishu, Somalia.
Department of Radiology, Mogadishu Somali Turkey, Training and Research Hospital, Mogadishu, Somalia.
Vasc Health Risk Manag. 2022 Jul 28;18:589-593. doi: 10.2147/VHRM.S371373. eCollection 2022.
Nephrotic Syndrome (NS) patients are prone to develop deep venous thrombosis as a complication. But it is unusual to present initially with multiple venous thrombosis and pulmonary artery thrombosis before the diagnosis of NS. Here, we present 60 years old female patient with a known history of diabetes mellitus who presented with shortness of breath and lower limb edema for 2 weeks. CT angiography showed thromboembolism at the right main pulmonary artery and its bronchus intermedius, lower and segmental with right lower lobe small pulmonary infarction and inferior vena cava (IVC) thrombosis extending in both renal veins, right common and left common iliac vein, moderate ascites. Her 24-hour urinary protein was 6.7g. a diagnosis of NS was reached and she was admitted to the ward. Anticoagulation with heparin and warfarin, methyl prednisone, and furosemide was initiated. After she become clinically stable, she was discharged with oral medications. Awareness of the complication of nephrotic syndrome is important not only to nephrologists but to all physicians. Using contrast-enhanced computed tomography to diagnose multiple venous and pulmonary arterial thrombosis is critical. Additionally, it is known that steroid-resistant NS, like membranous glomerulonephritis, are more susceptible to the complication of thromboembolism than steroid-sensitive NS. Contrast venography is used to diagnose DVT. CTPA is the gold standard test for pulmonary embolism.
肾病综合征（NS）患者易发生深静脉血栓形成等并发症。但在诊断为 NS 之前，最初就出现多发性静脉血栓形成和肺动脉血栓形成的情况并不常见。在此，我们介绍一位 60 岁的女性患者，她患有糖尿病病史，因呼吸困难和下肢水肿 2 周就诊。CT 血管造影显示右主肺动脉及其中间支气管、下段和节段性，右下叶小肺梗死和下腔静脉（IVC）血栓延伸至双侧肾静脉、右髂总静脉和左髂总静脉，中等量腹水。她的 24 小时尿蛋白为 6.7g。诊断为 NS，收入病房。给予肝素和华法林、甲基强的松龙和呋塞米抗凝治疗。她临床稳定后，改为口服药物出院。不仅肾病学家，而且所有医生都应该意识到 NS 的并发症。使用增强 CT 诊断多发性静脉和肺动脉血栓形成至关重要。此外，已知与激素敏感型 NS 相比，激素耐药型 NS，如膜性肾小球肾炎，更容易发生血栓栓塞并发症。对比静脉造影用于诊断 DVT。CTPA 是诊断肺栓塞的金标准。
