Nephrotic syndrome (NS) is an acquired hypercoagulable state in which thromboembolic phenomena and pulmonary thromboembolism [PTE] are well recognized complications that can contribute to mortality if not managed well in time.
Material & Methods
We retrospectively analyzed the clinical course and outcome of children with NS who were admitted in the, PGIMER with a diagnosis of PTE from January 2005 to April 2008. The children were clinically suspected to have PTE if they developed sudden onset respiratory distress, cough, wheeze or hypoxemia. The diagnosis of PTE was confirmed by ventilation perfusion scan showing moderate to high probability & CT scan confirmed the diagnosis.
Results
A total of 9 children developed PTE; seven were diagnosed ante-mortem while two at necropsy. PTE occurred mostly as an inpatient complication between day 1 to day 9 of hospitalization. All children had presented in relapse with edema, heavy proteinuria and hypoalbuminemia. Ventilation perfusion scans revealed high probability of PTE in 5 and intermediate probability in 2 patients. Co-existing infections were identified in four patients (spontaneous bacterial peritonitis 3, meningitis 1). Doppler scan did not reveal co-existent deep venous thrombosis in any child. Surrogate marker of thrombosis (D-dimer test) was found to be positive in four patients. All the seven patients were anticoagulated using conventional heparin and later overlapped with warfarin as a single daily dose titrating with the internationalized normalized ratio of 2-4 with good outcome.
Conclusion
High index of clinical suspicion for diagnosing PTE in children with NS is necessary for a favorable outcome.