关键词: 肾病综合征, 脑静脉窦血栓, 磁共振静脉血管成像

Abstract:

ABSTRACT    Objective: To make analysis of the clinical features of adult nephrotic syndrome complicated with cerebral venous sinus thrombosis (CVST). Methodology:The clinical features, laboratory findings, treatment and outcome of fourteen aldut patients with nephrotic syndrome complicated with CVST from 2009 to 2013 were retrospectively analyzed. The magnetic resonance venography method was used to observe the occurrence of cerebral venous sinus thrombosis. Results:They were 10 males and 4 femals with an average age of 24.5 ± 7.6 years old (ranged from 19 to 44). 9 cases were performed renal biopsy, the histological diagnosis was minimal change in 5 cases, FSGS one, IgAN (minimal change disease-like) one, IgMN one and membranous nephropathy in one case. CVST usually affected 6 sites of sinus, the transverse sinus in 13 cases, sagittal sinus 12 cases, sigmoid sinus 10 cases, sagittal sinus 3 cases, straight sinus 4 cases, and sinus confluences in 3 cases, which accompanied by the left upper extremity venous thrombosis one case, right ventricular mural thrombus one case and pulmonary embolism one case and left internal jugular venous thrombosis one case. 11 cases had CVST when nephrotic syndrome relapsed, and 3 cases complicated with CVST when nephrotic syndrome first happened. The common clinical characteristics were headache, nausea and vomiting, epilepsy was in 2 case and blurred vision in one case. The hypokalemia or hyponatremia due to diuretics was in 4 cases, mild edema of the lower limbs in 3cases and no edema in 11 cases. D-dimer were increased (1.88±1.82mg/l), Hb was high (16.2 ± 2.12g/dl), and anticardiolipin antibody IgM positive was in 2 cases.One case was given Batroxobin, the rest of all recieved low molecular weight heparin, unfractionated heparin anticoagulant and warfarin replaced, INR was maintained 2 to 3. Glycerol and fructose and diuretics was added to reduce intracranial pressure. After immunosuppressive therapy, keeping 20-30mg/d prednisone, all of the patients had got completely remission. During follow up, the thrombus of CVST disappeared in varied degree, none was dead, only one had thrombosis worse because of disesae relapse. Conclusion: CVST in nephrotic syndrome usually presents headache, nausea and vomiting associated with elevated D-dimer, and highly concentrated blood. Once patients have headache, seizure and hemiplegia, clinicians must be aware of CVST.Therefore it is necessary for them perform MRV angiography as soon as possible to make the right diagnosis.

Key words: nephrotic syndrome, cerebral venous sinus thrombosis, magnetic resonance venography