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Konopásek P, Piteková B, Krejčová V, Zieg J. Cerebral sinovenous thrombosis in children with nephrotic syndrome: systematic review and one new case. Front Pediatr 2023; 11:1207871. [PMID: 37691772 PMCID: PMC10484110 DOI: 10.3389/fped.2023.1207871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/17/2023] [Indexed: 09/12/2023] Open
Abstract
Aim The aim of this review is to provide clinicians with characteristics of children with nephrotic syndrome and cerebral sinovenous thrombosis (CSVT). Methods We have reviewed 37 articles of pediatric cases and provided 1 new case. PRISMA guidelines were followed. Results Sixty-two patients were included in the review. CSVT was more common in males, usually occurred within 6 months of nephrotic syndrome onset and was found more often in outpatients. The superior sagittal sinus was the most common sinus affected. Non-contrast computed tomography was the most frequent radiologic study performed, with 30% of results negative for CSVT. Headache and vomiting were the most common symptoms while neurologic symptoms were less frequent. Anticoagulation treatment was strongly inconsistent throughout the literature. Thrombosis outcomes were favorable. The most common possible risk factors were corticosteroid treatment, proteinuria and hypoalbuminemia. Four children had a genetic predisposition diagnosed after thrombosis. No markers for anticoagulation prophylaxis seemed to be relevant for the majority of thrombosis occurring in outpatients. Conclusion Prophylactic anticoagulation does not seem reasonable to prevent CSVT. Knowledge of nonspecific symptoms and of nephrotic syndrome being a state of hypercoagulation and early use of appropriate radiologic study seem to be of major importance.
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Affiliation(s)
- Patrik Konopásek
- Department of Pediatric Nephrology, 2nd Faculty of Medicine, University Hospital Motol, Charles University, Prague, Czechia
| | - Barbora Piteková
- Department of Pediatric Urology, Faculty of Medicine, Comenius University and National Institute of Children’s Diseases, Bratislava, Slovakia
| | - Vlasta Krejčová
- Department of Pediatric Nephrology, 2nd Faculty of Medicine, University Hospital Motol, Charles University, Prague, Czechia
| | - Jakub Zieg
- Department of Pediatric Nephrology, 2nd Faculty of Medicine, University Hospital Motol, Charles University, Prague, Czechia
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Parija S, Dash N, Jeyaraj G. Sixth cranial nerve palsy and dense cerebral venous sinus thrombosis in a child with nephrotic syndrome. BMJ Case Rep 2023; 16:e254044. [PMID: 37270177 PMCID: PMC10255118 DOI: 10.1136/bcr-2022-254044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Nephrotic syndrome (NS) is a common glomerular disease characterised by massive proteinuria, hypoalbuminaemia, oedema and hyperlipidaemia. Cerebral venous sinus thrombosis (CVST) is a rare complication in children with NS. Here, we report a case of relapsing NS on steroid therapy, in a male in early childhood who presented with symptoms of headache, vomiting and double vision. On prism cover test there was 25 PD esotropia with abduction restriction in the left eye. Fundus examination showed bilateral papilloedema. He was diagnosed as sixth cranial nerve palsy of left eye. Neuroimaging reported dense CVST. He was managed with subcutaneous low molecular weight heparin and steroids. After 2 months of treatment, there was a complete resolution of esotropia and optic disc oedema. This case highlights the importance of early diagnosis of acute onset esotropia and sagittal sinus thrombosis in a case of NS.
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Affiliation(s)
- Sucheta Parija
- Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| | - Nikita Dash
- Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| | - Genickson Jeyaraj
- Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
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da Silva Filha R, Burini K, Pires LG, Brant Pinheiro SV, Simões E Silva AC. Idiopathic Nephrotic Syndrome in Pediatrics: An Up-to-date. Curr Pediatr Rev 2022; 18:251-264. [PMID: 35289253 DOI: 10.2174/1573396318666220314142713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/31/2021] [Accepted: 12/12/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Idiopathic or Primary Nephrotic Syndrome (INS) is a common glomerular disease in pediatric population, characterized by proteinuria, edema and hypoalbuminemia with variable findings in renal histopathology. OBJECTIVE This review aims to summarize current data on the etiopathogenesis diagnosis, protocols of treatment and potential therapeutic advances in INS. METHODS This narrative review searched for articles on histopathology, physiopathology, genetic causes, diagnosis and treatment of INS in pediatric patients. The databases evaluated were PubMed and Scopus. RESULTS INS is caused by an alteration in the permeability of the glomerular filtration barrier with unknown etiology. There are several gaps in the etiopathogenesis, response to treatment and clinical course of INS that justify further investigation. Novel advances include the recent understanding of the role of podocytes in INS and the identification of genes associated with the disease. The role of immune system cells and molecules has also been investigated. The diagnosis relies on clinical findings, laboratory exams and renal histology for selected cases. The treatment is primarily based on steroids administration. In case of failure, other medications should be tried. Recent studies have also searched for novel biomarkers for diagnosis and alternative therapeutic approaches. CONCLUSION The therapeutic response to corticosteroids still remains the main predictive factor for the prognosis of the disease. Genetic and pharmacogenomics tools may allow the identification of cases not responsive to immunosuppressive medications.
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Affiliation(s)
- Roberta da Silva Filha
- Faculty of Medicine, Interdisciplinary Laboratory of Medical Investigation, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Kassia Burini
- Faculty of Medicine, Interdisciplinary Laboratory of Medical Investigation, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Laura Gregório Pires
- Faculty of Medicine, Interdisciplinary Laboratory of Medical Investigation, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | | | - Ana Cristina Simões E Silva
- Faculty of Medicine, Interdisciplinary Laboratory of Medical Investigation, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.,Department of Pediatrics, Unit of Pediatric Nephrology, Faculty of Medicine, UFMG, Belo Horizonte, MG, Brazil
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Rong L, Chen L, Dong Z, Zhuang H, Lin Z, Mo Y, Jiang X. Analysis of 10 Pediatric Nephrotic Syndrome Cases With Complications of Cerebral Sinovenous Thrombosis. Front Pediatr 2020; 8:607776. [PMID: 33425818 PMCID: PMC7786383 DOI: 10.3389/fped.2020.607776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/24/2020] [Indexed: 11/13/2022] Open
Abstract
Background: To analyze the clinical characteristics of nephrotic syndrome (NS) with complications of cerebral sinovenous thrombosis (CSVT) in children. Method: Clinical, radiographic, laboratory, and treatment data obtained from 10 confirmed cases of NS with complications of CSVT were analyzed. All patients were followed up for at least 18 months. CSVT was diagnosed by cerebral computed tomography (CT) and/or magnetic resonance imaging (MRI) with or without magnetic resonance venography (MRV) of the cerebral vessels. Results: Among 10 cases reported, 4 were steroid-sensitive NS with frequent relapse, 5 were steroid-resistant (three of them had renal biopsies showing two minimal change disease and one IgA nephropathy), and 1 was steroid-sensitive with one relapse. Common clinical manifestations were headache or ophthalmodynia complicated by vomiting, dizziness, convulsion, and coma. Neuropathologic signs were positive in some cases. Papilledema appeared in only one case with winding of vein. Cerebrospinal fluid was examined in three cases with elevated pressure but normal cytological and biochemical results. D dimer and fibrinogen levels were elevated while prothrombin time and activated partial thromboplastin time were shortened. Five out of seven cases who had performed cranial CT were suspicious for cerebral thrombosis. Nine cases had cranial MRI with abnormal signs in seven cases. All of the cases received MRV, confirming the diagnosis of CVST. Conclusion: Clinical manifestations of NS with CSVT are not specific but varied. Therefore, CSVT should be considered once nervous manifestations present. MRV is a better method in the diagnosis of CSVT.
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Affiliation(s)
- Liping Rong
- Department of Pediatrics, The Children Kidney Center, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lizhi Chen
- Department of Pediatrics, The Children Kidney Center, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhi Dong
- Department of Radiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hongjie Zhuang
- Department of Pediatrics, The Children Kidney Center, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhilang Lin
- Department of Pediatrics, The Children Kidney Center, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ying Mo
- Department of Pediatrics, The Children Kidney Center, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyun Jiang
- Department of Pediatrics, The Children Kidney Center, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Gera DN, Patel J, Patel K, Kute VB. Portal Vein Thrombosis: A Rare Complication of Nephrotic Syndrome. Indian J Nephrol 2018; 28:236-239. [PMID: 29962677 PMCID: PMC5998725 DOI: 10.4103/ijn.ijn_25_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Deep vein thrombosis, renal vein thrombosis, and cerebral venous sinus thrombosis in children are frequently described complications of nephrotic syndrome (NS). Early diagnosis and treatment with anticoagulants is the key for a good outcome. There are a few reported cases of portal vein and superior mesenteric thrombosis in adults in association with NS. Here, we describe two cases of portal vein thrombosis with variable extent of involvement of superior mesenteric vein in association with relapse of NS. A high degree of suspicion, ultrasonography of the abdomen along with Doppler study of abdominal vessels, and computed tomography angiography can only pick up such unusual sites of thrombosis and facilitate early management.
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Affiliation(s)
- D N Gera
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - J Patel
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - K Patel
- Department of Radiology, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - V B Kute
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
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Kumar M, Malhotra A, Gupta S, Singh R. Thromboembolic complications at the onset of nephrotic syndrome. Sudan J Paediatr 2017; 17:60-63. [PMID: 29545667 DOI: 10.24911/sjp.2017.2.8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Nephrotic syndrome is associated with hypercoagulable states and a subsequent high risk of venous and rarely arterial thromboembolism. Although venous thromboembolism has been a recognised risk, prevalence of pulmonary embolism in patients with nephrotic syndrome is based on data from different case series. Here we report a 5 year old child with nephrotic syndrome who developed life threatening cerebral dural venous sinus thrombosis and pulmonary embolism within a month of disease onset.
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Affiliation(s)
- Mritunjay Kumar
- Department of Pediatrics, SGRR Institute of Medical and Health Sciences, Dehradun, India
| | - Ankur Malhotra
- Department of Radiodiagnosis, SGRR Institute of Medical and Health Sciences, Dehradun, India
| | - Sourabh Gupta
- Department of Pediatrics, SGRR Institute of Medical and Health Sciences, Dehradun, India
| | - Ragini Singh
- Department of Pediatrics, SGRR Institute of Medical and Health Sciences, Dehradun, India
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Cerebral sinus venous thrombosis in a child with nephrotic syndrome. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2014; 19:339. [PMID: 25274600 PMCID: PMC4727679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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