Abstract:

Objective: To study the clinical and laboratory features of thromboembolic complications in the adult patients in different pathological types with nephrotic syndrome.  Methodology: Forty-two biopsy-proven adult nephrotic syndrome patients with thromboembolic complications were enrolled in this retrospective study. According to their pathological types three groups were divided. They were 9 (21.4%) cases of minimal change disease (MCD,), 10 (23.8%) cases of focal segemental glomerulosclerosis (FSGS), and 23 (54.8%) cases of membranous nephrosis (MN). The iconography method of diagnosis of thrombus: pulmonary artery, venae cavae, renal vessels by computer tomography angiography (CTA); limb vessels by compression ultrasonography; and magnetic resonance angiography (MRA) for the central nervous system vessels. Results: （1）The age was from 9 to 65 years old. There was no difference between the age and gender in these three groups. The mean age in MN was 36.2±17.0 years old, which was lower than the data from the literature（P<0.05）. (2) The thromboembolic complications could appear any time of the NS duration, it most likely happened in relapse phage of MCD, but the resistant NS in MN was very common. (3)The most common vessels’ sites of thrombus were renal vein (21 cases), pulmonary artery (15 cases) and venae cavae (10 cases). 90.5% patients with RVT and 60% patients with PE were from MN. Every MN patients had average 1.87 sites of thrombus, which was significant higher than MCD (1.1) and FSGS (1.1). (4) Microscopic or gross hematuria, lumbodynia, and increased kidney volume were the most common clinical symptoms in RVT. The frequent symptoms in PE were chest pain, dyspnea, and hemoptysis, but few patients were asymptomatic. （5）In patients with MN, the serum albumin were higher than that in MCD and FSGS, but the cholesterol, hemoglobin, haematocrit, and platelets were lower than that MCD and FSGS. The plasma AT-III levels of MCD and FSGS were lower than that of MN (P value were both less than 0.05). The positive rate of D-Dimer was 86.5%. Conclusion: The thromboembolic complications in patients with NS are very frequent. The embolic duration, site and laboratory data were various in different nephrotic syndrome pathological types. Few patients were asymptomatic with thrombus. Although the D-Dimer is the sensitive marker, it should not neglect the thrombus for the negative result.