title: [Nephrotic syndrome revealed by pulmonary embolism: about four cases].
abstract: Nephrotic syndrom is an association of proteinuria>3g/d or 50mg/kg/d, an hypoalbuminemia<30g/L and a hypoproteinemia<60g/L. Primary etiologies are minimal glomerular injury, focal segmental glomerulosclerosis and non membranous glomerulonephritis. Secondary etiologies are diabetes, high blood pressure and amyloidosis. We present four cases about nephrotic syndrome after thromboembolic disease. In every case, patients show a pulmonary embolism symptomatic of a nephrotic syndrom, whose diagnostic could be delayed up to six months after first pulmonary symptoms. This raised the problem of renal biopsy in these patients who need anticoagulation. In minimal change nephrosis, without hematuria, high blood pressure or renal dysfonction, a corticosteroid therapy test could be done assuming that is corticosensitive minimal glomerular injury. In every case, anticoagulation course must be completed and maintained in case of patent nephrotic syndrom with an albuminemia under 20g/L. In case of pulmonary embolism or deep vein thrombosis, idiopathic-looking, a nephrotic syndrome must be sought-after. The two diagnosis ways are the proteinuria on the urine dipstick and the hypoproteinemia on usual biology. The main mechanism is the coagulation factor leak, side effect of the nephrotic syndrom, notably because of the antithrombin III.
authors.affiliation: Service de cardiologie, centre hospitalier St-Joseph-St-Luc, 20, quai Claude-Bernard, 69007 Lyon, France.
authors.forename: E
authors.initials: E
authors.lastname: Chaudesaygues
authors.affiliation: Service de cardiologie, centre hospitalier St-Joseph-St-Luc, 20, quai Claude-Bernard, 69007 Lyon, France.
authors.forename: M
authors.initials: M
authors.lastname: Grasse
authors.affiliation: Service de cardiologie, centre hospitalier St-Joseph-St-Luc, 20, quai Claude-Bernard, 69007 Lyon, France.
authors.forename: L
authors.initials: L
authors.lastname: Marchand
authors.affiliation: Service de néphrologie, centre hospitalier St-Joseph-St-Luc, 69007 Lyon, France.
authors.forename: E
authors.initials: E
authors.lastname: Villar
authors.affiliation: Service de cardiologie, centre hospitalier St-Joseph-St-Luc, 20, quai Claude-Bernard, 69007 Lyon, France. Electronic address: jfaupetit@ch-stjoseph-stluc-lyon.fr.
authors.forename: J-F
authors.initials: JF
authors.lastname: Aupetit
mesh_terms: D000328:Adult; D000368:Aged; D000990:Antithrombin III / Q000652:urine; D057210:Delayed Diagnosis; D004359:Drug Therapy, Combination; D015150:Echocardiography, Doppler; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009025:Morpholines / Q000627:therapeutic use; D009404:Nephrotic Syndrome / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D011241:Prednisone / Q000627:therapeutic use; D011507:Proteinuria / Q000175:diagnosis / Q000188:drug therapy / Q000652:urine; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000188:drug therapy; D000069552:Rivaroxaban; D013876:Thiophenes / Q000627:therapeutic use; D020246:Venous Thrombosis / Q000175:diagnosis / Q000188:drug therapy
chemical_list: D009025:Morpholines; D013876:Thiophenes; D000990:Antithrombin III; D000069552:Rivaroxaban; D011241:Prednisone
keywords: Deep vein thrombosis; Embolie pulmonaire; Maladie thrombo-embolique veineuse; Nephrotic syndrom; Proteinuria; Protéinurie; Pulmonary embolism; Syndrome néphrotique; Thromboembolic disease; Thrombose veineuse profonde