肾病综合征是一种以蛋白尿为特征的疾病,低蛋白血症,水肿,高脂血症,和高凝状态。肾病综合征可能导致多种并发症,包括,但不限于,感染风险增加,呼吸窘迫,和血栓栓塞。肾病综合征有几种病因,包括特发性,自身免疫性疾病,感染(人类免疫缺陷病毒,丙型肝炎病毒,乙型肝炎病毒),毒品,重金属中毒.这里,我们报道一例37岁男性,表现为劳力性呼吸困难和双侧下肢肿胀恶化.在肾功能恶化的情况下,他被发现在静脉和动脉系统中同时出现多个急性血栓。进一步调查显示该患者患有膜性肾病。抗凝和免疫抑制的启动对他的生存产生了重大影响。血管血栓栓塞(VTE)并发症可能是促使肾病综合征患者寻求医疗护理的最初表现。因此,临床医生必须高度怀疑并发VTE和肾病性蛋白尿的患者。此外,鉴于肾病综合征的各种病因的治疗方式差异很大,区分患者的肾病综合征类型也很重要,这决定了治疗算法。
Nephrotic syndrome is a condition characterized by proteinuria, hypoalbuminemia, edema, hyperlipidemia, and a hypercoagulable state. Nephrotic syndrome may lead to several complications, including, but not limited to, increased risk of infection, respiratory distress, and thromboembolism. There are several etiologies of nephrotic syndrome with various predisposing factors ranging from idiopathic, autoimmune diseases, infections (human immunodeficiency virus, hepatitis C virus, hepatitis B virus), drugs, and heavy metal poisoning. Here, we report the
case of a 37-year-old male who presented with worsening exertional dyspnea and bilateral lower extremity swelling. He was found to have simultaneous multiple acute thromboses in both the venous and arterial systems in the setting of worsening renal function. Further investigation revealed that the patient had membranous nephropathy. Initiation of anticoagulation and immunosuppression made a significant difference in his survival. Vascular thromboembolic (VTE) complications may be the initial presentation that prompts patients with nephrotic syndrome to seek medical care. As such, clinicians must have a high index of suspicion in patients presenting with concurrent VTE and nephrotic-range proteinuria. In addition, given that treatment modalities for the various etiologies of nephrotic syndrome differ considerably, it is also essential to distinguish the type of nephrotic syndrome in a patient, which dictates the treatment algorithm.