| Is routine screening examination necessary for detecting
thromboembolism in childhood nephrotic syndrome? |
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Mun Sub Kim1, Ja Wook Koo1, Soung Hee Kim2 |
1Department of Pediatrics, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
2Departments of Radiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea |
| 소아 신증후군 환자에서 혈전증 검색을 위해screening 검사가 필요한가? |
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김문섭1, 구자욱1, 김성희2 |
1인제대학교 의과대학 상계백병원 소아청소년과
2인제대학교 의과대학 영상의학과 |
Correspondence:
Ja Wook Koo, Email: koojw9@sanggyepaik.ac.kr
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| Abstract |
Purpose
: The incidence of thromboembolic episodes in children with nephrotic syndrome (NS) is low; however, these episodes are often severe. Moreover, both pulmonary thromboembolism (PTE) and renal vein thrombosis (RVT) rarely show clinical symptoms. This study was performed to determine the benefits of routine screening in the detection of thrombosis in childhood NS.
Methods
: Among 62 children with nephrotic syndrome, a total of 54 children (43 males, 11 females) were included in this study. When the patients experienced their first NS episode, we performed renal Doppler ultrasonography in order to detect RVT. To rule out the possibility of PTE, a lung perfusion scan was performed. Computed tomographic (CT) pulmonary angiography was recommended to patients who showed possible signs of PTE. All patients were evaluated for clinical signs of thrombosis, biochemical indicators of renal disease, as well as clotting and thrombotic parameters.
Results
: RVT or related clinical symptoms were not observed in any children. Based on the findings of the lung perfusion scans, 15 patients (27.8%) were observed with as a high probability of PTE. We were able to perform a CT pulmonary angiography only on 12 patients, and 5 patients were diagnosed with PTE (prevalence 8.1%). The serum fibrinogen level in the group with PTE was significantly higher (776.7¡¾382.4 mg/dL, P<0.05) than that in the group without PTE, and other parameters were not significantly different between each group.
Conclusion
: Further studies are required for clarifying the role of renal Doppler ultrasonography for the detection of RVT in NS. Children with NS who developed non-specific respiratory symptoms should be evaluated for the diagnosis of PTE. In the management of NS, a lung perfusion scan should be performed at the time of the initial episode of NS regardless of the pulmonary symptoms, since patients having PTE are either often asymptomatic, or present with nonspecific symptoms. |
| Key Words:
Nephrotic syndrome, Pulmonary thromboembolism, Doppler ultrasonography, Lung perfusion scan |
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