Nephrotic syndrome and thromboembolic complications

Abstract

Thromboembolic phenomena in patients with nephrotic syndrome are one of the most feared complications due to its associated vital risk. 

Objective: To describe the major physiopathologic mechanisms responsible for the development of this type of complication, analyzing four clinical cases. 

Case-Reports: three of them presented with cerebral thromboembolic phenomena and one related to an extense inferior limb thrombosis associated to respiratory distress. The interactions between four conditions: unbalanced activity of procoagulant/anticoagulant molecules, thrombocytosis, platelet hyperaggregation and blood hyperviscosity promote an hypercoagulability state that leads to the development of thromboembolic complications, although the underlying physiopathologic mechanisms have not been completely clarified. The presence of other factors such as infections, circulating immune complexes, hypovolemia, arterial hypertension, steroid therapy, venipuncture and inmobilization may also play a role in the thrombogenesis associated to nephrotic syndrome. 

Conclusions: We conclude emphatising some therapeutic considerations such as judicious diuretics use, prevention of infections, adequate albumin levels and use of antiplatelet drugs and/or anticoagulants.