title: Coagulopathy and spontaneous hemorrhage in a patient with nephrotic syndrome.
abstract: Patients with nephrotic syndrome, particularly those with membranous nephropathy tend to be in a hypercoagulable state and often present with thromboembolic phenomena. The association of nephrotic syndrome with a bleeding diathesis however is much less common and the etiologies less well recognized. We report a patient who presented with coagulopathy and recurrent spontaneous hemorrhage in association with nephrotic syndrome. The case highlights key diagnostic and therapeutic challenges and strategies: 1) work up to establish a unifying etiology for both nephrotic syndrome and the bleeding disorder; 2) decision making to obtain a tissue biopsy, select the site of biopsy and understand the relative yields for each site; 3) recognizing the risk and managing peri-procedural bleeding; and 5) developing a treatment strategy with the lowest risk of possible complications. Our patient underwent a kidney biopsy without any complications and a definitive diagnosis of AL amyloidosis was reached. He was treated with anti-plasma cell chemotherapy followed by autologous stem cell transplant with resultant complete hematologic response, improved coagulation parameters, and no further bleeding.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Wayne State University, and Department of Oncology, Karmanos Cancer Center, Detroit, MI, USA.
authors.forename: Wihib
authors.initials: W
authors.lastname: Gebregeorgis
authors.forename: Unnikrishnan
authors.initials: U
authors.lastname: Pillai
authors.forename: Hirva
authors.initials: H
authors.lastname: Mamdani
authors.forename: Jay
authors.initials: J
authors.lastname: Yang
authors.forename: Noreen F
authors.initials: NF
authors.lastname: Rossi
mesh_terms: D000328:Adult; D001778:Blood Coagulation Disorders / Q000209:etiology*; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D009404:Nephrotic Syndrome / Q000097:blood* / Q000473:pathology