Abstract
The incidence of thromboembolic complications (TEC) in patients with nephrotic syndrome (NS) is about 1.8-5%, but may be underestimated. Most patients with TEC are asymptomatic.
We report a case of an 18-years old female patient on hormonal contraception with irrelevant family and personal history presenting a clinical picture of dyspnea, chest pain, collapse and discrete edemas of eyelids, arms and legs. On echocardiography were indirect signs of pulmonary hypertension, dilation and dysfunction of right ventricle, on ECG was right bundle branch block.
At this point, CT-angiography was performed and confirmed the bilateral massive pulmonary embolism (PE). Anticoagulation therapy with heparin and subsequently low-molecular heparin was started.
Ultrasound examination focused on detection of the source of embolism was negative, as well the clinical symptoms of previous deep vein thrombosis. Further examinations proved nephrotic proteinuria (6 g/m2/day), biochemical parameters corresponded to NS.
Renal biopsy proved the diagnosis of minimal change NS. Therapy with prednisone was started according to standard protocol with transient effect on proteinuria, during withdrawal of corticosteroids the proteinuria increased again.
After that, immunosuppressive therapy with cyclosporine A was initiated. The NS should be considered in differential diagnoses in patients with PE, all these patients should undergo urine testing for proteinuria.
As we demonstrate, massive PE can be rarely the first symptom of NS.