title: Thromboembolic complications in childhood nephrotic syndrome: a clinical profile.
abstract: BACKGROUND
  Thromboembolism is a rare life-threatening complication of childhood nephrotic syndrome.
  
  
  METHODS
  We present the clinical profile and outcome of 34 children with 35 events of thromboembolic complications with nephrotic syndrome.
  
  
  RESULTS
  Cerebral venous thrombosis (CVT) was the commonest complication seen in 11 (31.4 %) children followed by pulmonary thromboembolism and deep venous thrombosis in 9 (25.7 %) and 6 (16.6 %) children, respectively. Arterial thrombosis resulting in central nervous system infarcts was observed in 7 (20 %) children and 2 children had thrombosis of the peripheral arteries. Episodes were equal in steroid-resistant nephrotic syndrome and steroid-dependent nephrotic syndrome groups. Most of the thromboembolic complications occurred with relapse but 11.4 % of children developed intracranial thrombosis during remission. The most sensitive symptom of CVT was persistent headache while unexplained respiratory distress and hypoxemia pointed towards pulmonary thromboembolism. Hypoalbuminemia was seen in 82.8 % of children, while concurrent infection was seen in 31.4 %. Coexistence of genetic prothrombotic condition was identified and merits evaluation. Early heparin therapy followed by oral anticoagulants resulted in complete recovery in 91.1 % of children. Death occurred in 3 (8.5 %) children and autopsy revealed pulmonary thromboembolism in 2 children.
  
  
  CONCLUSIONS
  Venous and arterial thrombotic complications can occur in children with nephrotic syndrome. A high index of suspicion is required as the clinical features may be subtle. Neuroimaging and angiographic techniques help in confirming diagnosis. Early aggressive heparin therapy followed by oral anticoagulants is necessary for a favorable outcome.
authors.affiliation: Division of Allergy Immunology and Nephrology, Department of Pediatrics, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India, surideepti@gmail.com.
authors.forename: Deepti
authors.initials: D
authors.lastname: Suri
authors.forename: Jasmina
authors.initials: J
authors.lastname: Ahluwalia
authors.forename: Akshay K
authors.initials: AK
authors.lastname: Saxena
authors.forename: Kushaljit S
authors.initials: KS
authors.lastname: Sodhi
authors.forename: Paramjeet
authors.initials: P
authors.lastname: Singh
authors.forename: Bhagwant R
authors.initials: BR
authors.lastname: Mittal
authors.forename: Reena
authors.initials: R
authors.lastname: Das
authors.forename: Amit
authors.initials: A
authors.lastname: Rawat
authors.forename: Surjit
authors.initials: S
authors.lastname: Singh
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D009404:Nephrotic Syndrome / Q000150:complications* / Q000453:epidemiology; D012189:Retrospective Studies; D013923:Thromboembolism / Q000453:epidemiology / Q000209:etiology*