Sagittal sinus thrombosis - rare complication of nephrotic syndrome in a young child
Abstract
The nephrotic syndrome (NS) is caused by increased glomerular permeability. We report a case of NS in a 3-year-old girl, complicated with central nervous system venous thrombosis. Physical examination revealed anasarca (edema, pleurisy, and ascites), intensely foaming urine. The lab tests showed severe, non-selective proteinuria, marked hypoproteinemia, dyslipidemia; also associated with abnormal thyroid panel due to urinary binding protein loss. Once the diagnosis was established and pathogen-specific treatment was started, the clinical and paraclinical evolution were favorable. A prolonged right body seizure was the onset symptom of cerebral venous infarction due to sagittal sinus thrombosis. Short- and long-term outcomes of the thrombosis can be severe, so anticoagulant therapy was promptly initiated.
##plugins.themes.bootstrap3.article.details##
Nephrotic syndrome, edema, hypercoagulability, thrombosis, sagittal sinus
2. Dadgar K, Xue Y, Chung J, et al. Childhood nephrotic syndrome and the clinical profile of thromboembolism: a systematic review and meta-analysis. Pediatr Res 2023; 93:1463.
3. Meyrier A, Niaudet P. Acute kidney injury complicating nephrotic syndrome of minimal change disease. Kidney Int 2018; 94:861.
4. Chen TY, Huang CC, Tsao CJ. Hemostatic molecular markers in nephrotic syndrome. Am J Hematol 1993; 44:276.
5. Loscalzo J. Venous thrombosis in the nephrotic syndrome. N Engl J Med 2013; 368:956.
6. Abdelghani E, Waller AP, Wolfgang KJ, et al. Exploring the Role of Antithrombin in Nephrotic Syndrome-Associated Hypercoagulopathy: A Multi-Cohort Study and Meta-Analysis. Clin J Am Soc Nephrol 2023; 18:234.
7. Hogg RJ, Portman RJ, Milliner D, et al. Evaluation and management of proteinuria and nephrotic syndrome in children: recommendations from a pediatric nephrology panel established at the National Kidney Foundation conference on proteinuria, albuminuria, risk, assessment, detection, and elimination (PARADE). Pediatrics 2000; 105:1242.
8. Niaudet P. Steriod-sensitive idiopathic nephrotic syndrome in children. In: Pediatric Nephrology, 5th ed, Avner ED, Harmon WE, Niaudet P (Eds), Lippincott Williams & Wilkins, Philadelphia 2004. p.549.
9. Kerlin BA, Blatt NB, Fuh B, et al. Epidemiology and risk factors for thromboembolic complications of childhood nephrotic syndrome: a Midwest Pediatric Nephrology Consortium (MWPNC) study. J Pediatr 2009; 155:105.
10. Egli F, Elmiger P, Stalder G. [Thrombosis as a complication of nephrotic syndrome]. Helv Paediatr Acta 1973; 30:Suppl:20.
11. Llach F. Hypercoagulability, renal vein thrombosis, and other thrombotic complications of nephrotic syndrome. Kidney Int 1985; 28:429.
12. Rabelink TJ, Zwaginga JJ, Koomans HA, et al. Thrombosis and hemostasis in renal disease. Kidney Int 1994; 46:287.
13. Crew RJ, Radhakrishnan J, Appel G. Complications of the nephrotic syndrome and their treatment. Clin Nephrol 2004; 62:245.
14. Diaz JM, Schiffman JS, Urban ES, et al. Superior sagittal sinus thrombosis and pulmonary embolism: a syndrome rediscovered. Acta Neurol Scand 1992; 86:390.
15. Ferro JM, Aguiar de Sousa D. Cerebral Venous Thrombosis: an Update. Curr Neurol Neurosci Rep 2019; 19:74.
16. Schobess R, Düring C, Bidlingmaier C, et al. Long-term safety and efficacy data on childhood venous thrombosis treated with a low molecular weight heparin: an open-label pilot study of once-daily versus twice-daily enoxaparin administration. Haematologica 2006; 91:1701.
17. Moharir MD, Shroff M, Stephens D, et al. Anticoagulants in pediatric cerebral sinovenous thrombosis: a safety and outcome study. Ann Neurol 2010; 67:590.
18. Monagle P, Chan AK, Goldenberg NA, et al. Antithrombotic therapy in neonates and children: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141:e737S.
19. Ferro JM, Bousser MG, Canhão P, et al. European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis - endorsed by the European Academy of Neurology. Eur J Neurol 2017; 24:1203.
20. Ferro JM, Canhão P, Bousser MG, et al. Early seizures in cerebral vein and dural sinus thrombosis: risk factors and role of antiepileptics. Stroke 2008; 39:1152.
21. Lombel RM, Gipson DS, Hodson EM. Treatment of steroid-sensitive nephrotic syndrome: new guidelines from KDIGO. Pediatr Nephrol. 2013 Mar. 28(3):415-26.
22. Ueda N, Kawaguchi S, Niinomi Y, et al. Effect of corticosteroids on coagulation factors in children with nephrotic syndrome. Pediatr Nephrol. 1987;1(3):286-289. doi:10.1007/BF00849225
23. Canhão P, Ferro JM, Lindgren AG, et al. Causes and predictors of death in cerebral venous thrombosis. Stroke 2005; 36:1720.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Archive of Clinical Cases is protected by copyright and may be used in accordance with copyright and other applicable laws. Content available at www.clinicalcases.eu and our digital applications is intended for personal noncommercial use.
Authors who submit a manuscript for publication in Archive of Clinical Cases agree to the following terms: a. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. b. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. c. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) only after the final version of the manuscript was accepted and published, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access). d. It is compulsory that before submission authors ensure that their work was not published in any other medical journals or pending acceptance for publication and that "Archives of Clinical Cases" is the only beneficiary at that moment if their work/case will be accepted by us.
Guidelines for linking to www.clinicalcases.eu a. The main purpose of the site linking to the Archive of Clinical Casess site should be educational. b. Links should be made to the Archive of Clinical Casess home page (www.clinicalcases.eu) or to the articles abstract. c. It is forbidden to use the Archive of Clinical Casess cover by outside organizations unless permission has been granted in advance, notifying our Secretary. d. Material owned by the Archive of Clinical Cases (including the name, logo, cover, and text) may not be used in any manner that may induce the idea or suggest that the Archive of Clinical Cases is in some way recommending a specific company, product or service. e. You must not use or allow others to access or use, all or any part of our Site or the contents and/or applications on it for commercial purposes without our permission. To seek permission to do anything prohibited by or not contained in these TERMS, or which requires our prior consent or agreement, you can contact us.