title: Antithrombotic prophylaxis in a patient with nephrotic syndrome and congenital protein S deficiency.
abstract: BACKGROUND
  Nephrotic syndrome confers an acquired prothrombotic phenotype due to the urinary loss of anticoagulant proteins.Patients with reactivation of nephrotic syndrome may develop thrombosis.
  
  
  METHODS
  We report the case of a life-threatening cerebral venous thrombosis in a 13 year-old boy affected by a relapse of nephrotic syndrome during a P. aeruginosa otitis/mastoiditis. Due to the worsening general conditions and the severe neurological impairment, a course of systemic thrombolysis was successfully administered, followed by anticoagulant therapy. In the present case severe inherited thrombophilia (inherited dysfunctional protein S deficiency) was identified as an important additional risk factors for thrombosis.
  
  
  CONCLUSIONS
  A careful evalutaion of risk factos for thrombosi during reactivation of nephrotic syndrome include measurement of plasma anticaogulant proteins. When low, antithrombotic prophylaxis with heparin should be considered to prevent thrombotic episodes.
authors.affiliation: A.Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy. andrea.artoni@policlinico.mi.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Artoni
authors.affiliation: A.Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy. seremap@gmail.com.
authors.forename: Serena Maria
authors.initials: SM
authors.lastname: Passamonti
authors.affiliation: Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy. alberto.edefonti@policlinico.mi.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Edefonti
authors.affiliation: A.Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy. franiello@libero.it.
authors.forename: Francesca
authors.initials: F
authors.lastname: Gianniello
authors.affiliation: Neuroradiology Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Civelli
authors.affiliation: A.Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy. martin@policlinico.mi.it.
authors.forename: Ida
authors.initials: I
authors.lastname: Martinelli
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use; D001706:Biopsy; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D019934:International Normalized Ratio; D020767:Intracranial Thrombosis / Q000517:prevention & control*; D018810:Magnetic Resonance Angiography; D008297:Male; D017762:Nadroparin / Q000627:therapeutic use; D009404:Nephrotic Syndrome / Q000150:complications* / Q000188:drug therapy; D010375:Pedigree; D018455:Protein S Deficiency / Q000150:complications* / Q000188:drug therapy / Q000235:genetics; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D017762:Nadroparin; D014859:Warfarin; D006493:Heparin; D010959:Tissue Plasminogen Activator