De Masi De Luca Gabriele, Naticchia Alessandro, Palamà Zefferino, Maisto Carlo, Longo Simonetta, Colopi Marzia, Barba Francesca, De Masi De Luca Giuseppe, Marazia Stefania, Romano Silvio, Sciarra Luigi
Department of Life, Health and Environmental Science University of L'Aquila L'Aquila Italy.
Cardiology Unit Card. "G. Panico" Hospital Tricase Italy.
Respirol Case Rep. 2025 Jun 9;13(6):e70234. doi: 10.1002/rcr2.70234. eCollection 2025 Jun.
This case report presents a scenario of pulmonary embolism (PE) and renal vein thrombosis (RVT) in a young patient with a recent diagnosis of nephrotic syndrome (NS). The presence of a clinical condition characterised by a marked non-selective proteinuria, which may correlate with reduced drug concentration, has raised doubts about the most appropriate anticoagulant therapeutic choice. A 34-year-old male patient presented to the emergency department with dyspnea, chest pain and hypotension. Two days prior, the patient had undergone a renal biopsy for a recent NS finding. An urgent CT scan revealed a right pulmonary embolism and inferior left renal vein thrombus, prompting immediate anticoagulant therapy. The patient was discharged on rivaroxaban. The presence of NS and the consequent concern regarding potential decreased drug concentration led us to monitor rivaroxaban plasma concentrations during the treatment period. Monitoring showed a strong correlation between the extent of proteinuria and the drug concentration. At the 4-month follow-up after discharge from the hospital, the patient was performing normal daily activities without limitations, and angio-CT showed complete resolution of renal and pulmonary thrombotic formations. In this clinical case, pulmonary embolism associated with renal vein thrombosis in a patient with a recent diagnosis of NS was managed with rivaroxaban with a good clinical outcome.
本病例报告呈现了一名近期诊断为肾病综合征（NS）的年轻患者发生肺栓塞（PE）和肾静脉血栓形成（RVT）的情况。存在以显著非选择性蛋白尿为特征的临床状况，这可能与药物浓度降低相关，这引发了对于最合适抗凝治疗选择的疑问。一名34岁男性患者因呼吸困难、胸痛和低血压就诊于急诊科。两天前，该患者因近期发现肾病综合征而接受了肾活检。紧急CT扫描显示右肺栓塞和左肾下静脉血栓，随即开始进行抗凝治疗。患者出院时服用利伐沙班。肾病综合征的存在以及由此对潜在药物浓度降低的担忧促使我们在治疗期间监测利伐沙班的血浆浓度。监测显示蛋白尿程度与药物浓度之间存在密切相关性。出院后4个月的随访中，患者能够正常进行日常活动且无限制，血管CT显示肾和肺血栓形成完全消退。在本临床病例中，近期诊断为肾病综合征的患者发生的与肾静脉血栓形成相关的肺栓塞采用利伐沙班治疗，取得了良好的临床效果。
