scholarly journals Paraneoplastic syndrome as a possible cause of pulmonary thromboembolism in a female patient with nephrotic syndrome: Case report

2020 ◽  
Vol 45 (3) ◽  
pp. 114-117
Author(s):  
Jasmina Mrgud ◽  
Ana Jevrić ◽  
Vlastimir Vlatković ◽  
Branislav Gašić
Keyword(s):  
Nephrotic Syndrome ◽  
Female Patient ◽  
Bone Scintigraphy ◽  
General Condition ◽  
Low Voltage ◽  
Pulmonary Thromboembolism ◽  
Human Albumin ◽  
Heparin Therapy ◽  
General Weakness ◽  
Probable Consequence

A 59-year-old female patient was admitted to the hospital due to suffocation, lower leg swelling, and general weakness. She had been treated previously with immunosuppressive therapy for several years because of focal segmental glomerulosclerosis with nephrotic syndrome. The expected therapeutic response was not accomplished. Upon admission, the following were determined in the laboratory: hypoalbuminemia, hyperlipidemia and nephrotic range proteinuria. X-ray of the lungs showed bilateral pleural effusion, because of which a pleural puncture was performed and which drained 800 mL of fluid. Tumor markers test, breast echosonography and mammography were performed, along with bone scintigraphy, which was done upon the recommendation of an oncologist. Mammography described microcalcifications bilaterally while bone scintigraphy showed pathological accumulation of radiopharmaceuticals in the V thoracic vertebra and sternum corpus, and III and IV ribs on the left. On the fifth day of hospitalization, there was a deterioration of patient's general condition with hypotension, tachycardia and angina, as well as an increase in D-dimer. On the ECG sinus rhythm, f 80 / min, low voltage in standard and unipolar leads. Upon the recommendation of a cardiologist, CT was performed according to the program for pulmonary thromboembolism (PTE), which showed submassive PTE. Low molecular weight heparin therapy was used, along with oxygen therapy with dopaminergics, bronchodilators, human albumin and plasma infusions, statins and transient treatment of hypervolemia by means of hemodialysis. The patient was hospitalized for 61 days due to multiorgan dysfunction. Breast magnetic resonance imaging was not performed due to the poor general condition of the patient. Most likely it was breast cancer with secondary deposits, which was recognized late. PTE, as a probable consequence of paraneoplastic nephrotic syndrome, was diagnosed and treated in a timely manner.

Comparison of Progressive Antithrombin Activity and the Concentration of Three Thrombin Inhibitors in Nephrotic Syndrome

1981 ◽  
Vol 46 (03) ◽  
pp. 623-625 ◽  
Author(s):  
B Boneu ◽  
F Bouissou ◽  
M Abbal ◽  
P Sie ◽  
C Caranobe ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Antithrombin Iii ◽  
Heparin Therapy ◽  
Thrombin Inhibitors ◽  
Compensatory Mechanism ◽  
Dramatic Reduction ◽  
Antithrombin Activity ◽  
Α2 Macroglobulin ◽  
At Iii ◽  
A Prospective Study

SummaryIn order to compare the plasmatic progressive antithrombin activity to the concentration of three thrombin inhibitors, antithrombin III (AT III), α2 macroglobulin (α2, M), α1 anti-trypsin (α1 AT) in nephrotic syndrome, a prospective study was carried out on a group of 28 children affected with the disease. A dramatic reduction of the level of AT III and of α1 AT, two inhibitors of molecular weight close to that of albumin, was observed. The decreased level of AT III was counterbalanced by an increase in α2 M. This phenomenon accounts for the increased progressive antithrombin activity observed in all the affected children. It is suggested that the above compensatory mechanism explains the absence of thrombotic accidents in this series and that the benefit of heparin therapy is doubtful in these conditions.

scholarly journals Salt-poor Human Albumin in Management of Nephrotic Syndrome

BMJ ◽  
1974 ◽  
Vol 1 (5906) ◽  
pp. 481-484 ◽  
Author(s):  
A. M. Davison ◽  
A. T. Lambie ◽  
A. H. Verth ◽  
J. D. Cash
Keyword(s):  
Nephrotic Syndrome ◽  
Human Albumin

Spontaneous echoes due to hypoalbuminemia

2004 ◽  
Vol 14 (5) ◽  
pp. 560-561 ◽  
Author(s):  
Amir Hadash ◽  
Yulia Braver ◽  
Avraham Lorber
Keyword(s):  
Nephrotic Syndrome ◽  
Structure Function ◽  
Human Albumin ◽  
Cardiac Structure

We found spontaneous echoes in two teenagers with nephrotic syndrome and profound hypoalbuminemia, both having normal cardiac structure, function and output. The phenomenon disappeared after the level of albumin normalized. In one patient, all spontaneous echoes disappeared following convalescence, the level of albumin in the serum then being documented at normal levels. The second patient, who presented with profound hypoalbuminemia, was infused with human albumin because of oliguria, following which the spontaneous echoes disappeared.

scholarly journals The Unpredictability of Idiopathic Membranous Nephropathy: An Illustrative Case Report

2018 ◽  
Vol 8 (2) ◽  
pp. 103-106
Author(s):  
Murray L. Levin ◽  
Shubhada Ahya
Keyword(s):  
Nephrotic Syndrome ◽  
Case Report ◽  
Complete Remission ◽  
Female Patient ◽  
Membranous Nephropathy ◽  
Low Dose ◽  
Conservative Therapy ◽  
Current Knowledge ◽  
Illustrative Case ◽  
Cytomegalovirus Colitis

The case of a female patient with primary membranous nephropathy is presented. She was treated with corticosteroids and chlorambucil after conservative therapy had failed and went into remission for 5 years. Her nephrotic syndrome recurred but did not respond to the same regimen. She had another complete remission after treatment with corticosteroids and cyclosporine, but the nephrosis recurred after 7 years. Again, she failed to respond with retreatment of steroids plus cyclosporine. She was treated with alternate-day steroid plus mycophenolate and, once again, had a complete remission. She was maintained on low-dose mycophenolate for 7 more years. The mycophenolate had to be discontinued because of cytomegalovirus colitis. Treatment with ganciclovir abolished the colitis. She is still in remission 10 years later. The case is discussed with regard to current knowledge of the immune pathogenesis of membranous nephropathy as well as the unknowns of the immunogenesis of the disease.

scholarly journals Nephrotic syndrome after insect sting: a case report

2020 ◽  
Author(s):  
Vânia Junqueira ◽  
Beatriz Donato ◽  
Catarina Teixeira ◽  
Maria Isabel Mascarenhas ◽  
Isabel Costa Silva ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Case Report ◽  
Minimal Change Disease ◽  
Pulmonary Thromboembolism ◽  
Adult Population ◽  
Minimal Change ◽  
Sustained Remission ◽  
Insect Sting ◽  
Insect Stings ◽  
New Onset

ABSTRACT Minimal change disease accounts for up to 25% of the cases of nephrotic syndrome in adult population. The allergic mechanism has been associated with minimal change disease and allergens have been implied, namely insect stings. We present a case report of a woman with new onset of nephrotic syndrome after a non-hymenoptera insect sting, with biopsy-proven minimal change disease, that was accompanied by a pulmonary thromboembolism process. Complete remission with glucocorticoid therapy was observed, with sustained response for 6 months after discontinuation. A new exposure to insect sting in the same geographical region and season triggered a nephrotic syndrome relapse. Subsequent avoidance of the place resulted in a sustained remission for more than 4 years.

Lung scintigraphy in the diagnosis and follow-up of pulmonary thromboembolism in children with nephrotic syndrome

2005 ◽  
Vol 29 (5) ◽  
pp. 313-316 ◽  
Author(s):  
Bhagwant Rai Mittal ◽  
Surjit Singh ◽  
Anish Bhattacharya ◽  
Vikas Prasad ◽  
Baljinder Singh
Keyword(s):  
Nephrotic Syndrome ◽  
Pulmonary Thromboembolism ◽  
Lung Scintigraphy

Management of Suspected Acute Venous Thromboembolism in a General and Maternity Hospital

1996 ◽  
Vol 41 (2) ◽  
pp. 49-53
Author(s):  
J.B. Neilly ◽  
I.D. Walker ◽  
G.D.O. Lowe
Keyword(s):  
High Probability ◽  
Pulmonary Thromboembolism ◽  
Maternity Hospital ◽  
Pulmonary Angiography ◽  
Heparin Therapy ◽  
Activated Partial Thromboplastin Time ◽  
Average Daily Dose ◽  
Common Risk Factor ◽  
Daily Dose ◽  
Acute Venous Thromboembolism

A retrospective study of the management of patients with suspected acute deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE) in a general and maternity hospital was conducted over a two month period in 1992. Ninety six patients with suspected D VT/PTE were identified, of whom only two were pregnant. Forty four patients had suspected DVT and confirmatory investigations were performed in 84%. The most common risk factor for DVT was intra-venous drug (IVD) use. Unfractionated heparin was prescribed to all patients except one with acute DVT at an average daily dose of 25,000 iu. Inpatients receiving heparin, 68% had measurements of the activated partial thromboplastin time (APTT) ratio and on 38% of occasions the result was subtherapeutic. Complications of heparin therapy were infrequent. Fifty two patients had suspected PTE and 50 underwent ventilation/perfusion (V/Q) scanning. No patient underwent pulmonary angiography. The management of patients with normal, low and high probability V/Q scans was in keeping with the guidelines, but only 85%o of patients with an intermediate V/Q scan result had further investigations and 33% received heparin. This study revealed sub optimal anticoagulation of patients with acute DVT and scope for improvement in the management of patients with an intermediate V/Q scan result.

scholarly journals Plasma Exchange in the Management of Catastrophic Antiphospholipid Syndrome

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Dimitri Titeca-Beauport ◽  
Valery Salle ◽  
Loay Kontar ◽  
Julien Maizel ◽  
Gabriel Choukroun
Keyword(s):  
Plasma Exchange ◽  
Antiphospholipid Syndrome ◽  
General Condition ◽  
Oxygen Therapy ◽  
Single Case ◽  
Heparin Therapy ◽  
University Teaching ◽  
Optimal Timing ◽  
Rapid Improvement ◽  
Catastrophic Antiphospholipid Syndrome

Objective. Report of a case of catastrophic antiphospholipid syndrome (CAPS) with multiple organ involvement leading to a life-threatening condition despite early combination corticosteroid and heparin therapy. Initiation of plasma exchange led to rapid improvement of the patient’s general condition. Design. Case report. Setting. University teaching hospital medical intensive care unit. Patient. Single case: 52-year-old man hospitalized for catastrophic antiphospholipid syndrome (CAPS) with cardiac, renal, and cutaneous involvement. Despite early methylprednisolone and heparin therapy, the patient’s condition progressively deteriorated, resulting in acute renal failure, right adrenal hemorrhage, and pulmonary involvement, leading to acute respiratory distress on day 6, requiring high-flow nasal cannula oxygen therapy with FiO2 of 1.0. Interventions. Plasma exchange was started on day 6. Endpoints and Main Results. A marked improvement of the patient’s general condition was observed after initiation of plasma exchange, with successful weaning of oxygen therapy and normalization of platelet count, troponin, and serum creatinine within four days. Conclusions. This case illustrates the efficacy of plasma exchange in CAPS and the difficulty for physicians to determine the optimal timing of plasma exchange.

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