Thromboembolic complications in membranous nephropathy patients with nephrotic syndrome-a prospective study.
BACKGROUND
Venous thromboembolism (VTE) is one of the most serious complications in membranous nephropathy (MN). We investigate the incidence of VTE in MN patients with nephrotic syndrome (NS).


METHODS
A total of 100 MN patients with NS were enrolled into this prospective study. The diagnosis of VTE was based on contrast-enhanced dual source computed tomography angiography.


RESULTS
Venous thromboembolism was demonstrated in 36 patients (36%). 33 patients (33%) had renal vein thrombosis (RVT), 17 patients (17%) had pulmonary embolism (PE). Flank pain was noted in 5 patients and gross hematuria in 2 patients with RVT. Dyspnea and chest pain were present in 9 patients with PE. The positive predictive value for D-dimer level was 69.4%, negative predictive value for D-dimer level was 96.1% in patients with MN. Of all the risk factors presented, D-dimer level, proteinuria, the ratio of proteinuria to serum albumin were independent risk factors for the development of VTE (P<0.05), but the plasma level of antithrombin Ш was not correlated with VTE in this study. In follow up, venous thrombosis disappeared after anticoagulant treatment with low-molecular-weight heparins in 28 patients.


CONCLUSIONS
Venous thromboembolism was confirmed in 36% of MN patients with NS. Renal vein thrombosis and pulmonary embolism are common and usually asymptomatic. Computed tomography angiography can be used effectively to examine suspected patients. Measurement of D-dimer is helpful in VTE diagnosis. It is important that clinicians are aware that VTE should be considered as a common complication in MN patients with NS.
Research Institute of Nephrology, Jinling Hospital, Nanjing University of Medicine, Nanjing, 210002, China.
Shi-Jun
SJ
Li
Jing-Zhou
JZ
Guo
Ke
K
Zuo
Jiong
J
Zhang
Yang
Y
Wu
Chang-sheng
CS
Zhou
Guang-ming
GM
Lu
Zhi-hong
ZH
Liu
D000293:Adolescent; D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012082:Renal Veins / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D054556:Venous Thromboembolism / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D055815:Young Adult