title: Case series of thromboembolic complications in childhood nephrotic syndrome: Hacettepe experience.
abstract: BACKGROUND
  The aim of this study was to describe the incidence and contributory risk factors for thromboembolic complications in children with nephrotic syndrome (NS) and thrombosis.
  
  
  METHODS
  Among 188 children with the diagnosis of NS (80 girls; mean age: 12.6 ± 5.4 years) followed up in our hospital for the last 5 years, 17 (9.0 %) children (16 boys) identified as having thromboembolic complications. All 17 children with NS and thrombosis were screened for laboratory risk factors for thrombosis. The diagnosis was confirmed by cranial magnetic resonance imaging, doppler ultrasonography, and echocardiography.
  
  
  RESULTS
  Among 17 children with thrombosis, 14 (82.3 %) were found to have focal segmental glomerulosclerosis (FSGS) as underlying pathology by renal biopsy. The mean age of the thrombotic children was 4.5 ± 3.2 years at the diagnosis of NS and that was 7.1 ± 4.9 years at the time of thrombosis. The mean time from NS diagnosis to the first thrombosis development was 2.6 ± 2.3 years. Thrombosis occurred during the first year of NS in 9/17 (52.9 %) children. Most of the children (88.2 %) had venous thrombosis. Among the screened risk factors, high factor VIII level (64.7 %) was the leading factor followed by decreased antithrombin III level (29.4 %). Furthermore, 4 children had central venous catheters and 2 had infection as clinical risk factors for thrombosis.
  
  
  CONCLUSIONS
  In this case series, subtype of FSGS, active disease state of NS, central venous catheters, and some inherited and acquired thrombotic risk factors have been identified as contributory factors for the development of thrombosis in children with NS.
authors.affiliation: Pediatric Hematology Unit, Hacettepe Univesity Faculty of Medicine, Sihhiye, 06100, Ankara, Turkey.
authors.forename: Betul
authors.initials: B
authors.lastname: Tavil
authors.affiliation: Pediatric Nephrology Unit, Hacettepe Univesity Faculty of Medicine, Sihhiye, 06100, Ankara, Turkey.
authors.forename: Fehime
authors.initials: F
authors.lastname: Kara
authors.affiliation: Pediatric Nephrology Unit, Hacettepe Univesity Faculty of Medicine, Sihhiye, 06100, Ankara, Turkey. rezantopaloglu@hacettepe.edu.tr.
authors.forename: Rezan
authors.initials: R
authors.lastname: Topaloglu
authors.affiliation: Pediatric Hematology Unit, Hacettepe Univesity Faculty of Medicine, Sihhiye, 06100, Ankara, Turkey.
authors.forename: Selin
authors.initials: S
authors.lastname: Aytac
authors.affiliation: Pediatric Hematology Unit, Hacettepe Univesity Faculty of Medicine, Sihhiye, 06100, Ankara, Turkey.
authors.forename: Sule
authors.initials: S
authors.lastname: Unal
authors.affiliation: Pediatric Hematology Unit, Hacettepe Univesity Faculty of Medicine, Sihhiye, 06100, Ankara, Turkey.
authors.forename: Baris
authors.initials: B
authors.lastname: Kuskonmaz
authors.affiliation: Pediatric Hematology Unit, Hacettepe Univesity Faculty of Medicine, Sihhiye, 06100, Ankara, Turkey.
authors.forename: Mualla
authors.initials: M
authors.lastname: Cetin
authors.affiliation: Pediatric Nephrology Unit, Hacettepe Univesity Faculty of Medicine, Sihhiye, 06100, Ankara, Turkey.
authors.forename: Nesrin
authors.initials: N
authors.lastname: Besbas
authors.affiliation: Pediatric Hematology Unit, Hacettepe Univesity Faculty of Medicine, Sihhiye, 06100, Ankara, Turkey.
authors.forename: Fatma
authors.initials: F
authors.lastname: Gumruk
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D000990:Antithrombin III / Q000378:metabolism; D001241:Aspirin / Q000627:therapeutic use; D020520:Brain Infarction / Q000188:drug therapy / Q000209:etiology; D062905:Central Venous Catheters / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005169:Factor VIII / Q000378:metabolism; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D005923:Glomerulosclerosis, Focal Segmental / Q000150:complications; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics; D009154:Mutation; D009404:Nephrotic Syndrome / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D012307:Risk Factors; D017131:Thrombectomy; D013997:Time Factors; D014421:Turkey / Q000453:epidemiology; D020246:Venous Thrombosis / Q000097:blood / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy
chemical_list: D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D000990:Antithrombin III; D005169:Factor VIII; C573423:MTHFR protein, human; D042965:Methylenetetrahydrofolate Reductase (NADPH2); D001241:Aspirin
keywords: Children; Complication; Nephrotic syndrome; Thrombosis