Intracardiac thrombus--a rare complication of the steroid resistant nephrotic syndrome.
BACKGROUND
An intracardiac thrombus is extremely rare in children with the nephrotic syndrome (NS).


OBJECTIVE
To present a case report of a child with steroid resistant NS and intracardiac thrombus.


RESULTS
A 3.5-year-old boy with the first attack of steroid resistant NS was admitted to the hospital. A histological evaluation of the renal biopsy specimen revealed the minimal changes disease (MCD). There were no mutations in the podocin gene. The treatment with furosemide, albumin, prednisone, metylprednisolone, cyclophosphamide, enalapril and losartan was ineffective, as the intermittent oedema, proteinuria, hypoalbuminemia and hypercholesterolemia were still present. 8 weeks after the disease onset, the sinus tachycardia occurred and the echocardiography revealed a thrombus in the right ventricle, which had gradually proceeded to the pulmonary artery bifurcation. The thrombolysis with 40 mg of alteplase was initiated. Two hours after the alteplase application, the thrombus was not detectable. The mutational analysis of factors V, II and MFTHR genes were negative. The repeated echocardiography performed after 1 week, 2 and 6 months, respectively, revealed a normal cardiac function and morphology. The patient received prophylactic doses of fraxiparin for 3.5 months followed by warfarin. A remission of the nephrotic syndrome was achieved with high doses of cyclosporine A together with atorvastatin at 7 month after the disease onset.


CONCLUSIONS
The thromboembolism as a result of the hypercoagulation status is a serious complication of the nephrotic syndrome. The intracardiac localisation of thrombus is extremely rare (Fig. 2, Ref. 10). Full Text (Free, PDF) www.bmj.sk.
Department of Paediatrics, Charles University in Prague, Medical Faculty Hradec Kralove, Czech Republic. skalova.s@seznam.cz
S
S
Skalova
A
A
Lukes
H
H
Vanicek
T
T
Klein
J
J
Hak
P
P
Dedek
E
E
Ocenaskova
D002675:Child, Preschool; D004351:Drug Resistance; D004452:Echocardiography; D005938:Glucocorticoids / Q000627:therapeutic use*; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D008297:Male; D009404:Nephrotic Syndrome / Q000150:complications* / Q000188:drug therapy; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*
D005938:Glucocorticoids