Acute Venous Thrombosis of Splenomesenteric Portal Axis in Minimal Change Nephrotic Syndrome / 대한신장학회잡지

ABSTRACT

An association between nephrotic syndrome and thromboembolic phenomena has been known for many years. Most common sites of venous throm-bosis in nephrotic syndrome are al vein and deep vein of lower extremity. We report a case of minimal change nephrotic syndrome associated with unusual extensive venous thrombosis. A 29-year-old man was transferred to our hospital with severe abdominal pain and ascites. 2 months before admission, he was diagnosed as minimal change nephropathy at another hospital and treated with steroid therapy but he had persistent proteinuria on admission. The abdominal ultrasonography and CT scan revealed diffuse thrombosis of left renal vein, splenic vein, superior mesenteric vein and portal vein. Deep vein thrombosis of lower extremity was also found but not pulmonary embolism. There was no evidence of other primary hypercoagulable disease. He was treated with intravenous heparin immediately and three days later, abdominal pain disappeared. Prednisolone and cyclophosphamide were administered as well. After 1 month of therapy, proteinuria was resolved. Abdominal CT scan, taken after 2 months of therapy, revealed that diffuse thrombosis were almost resolved. From this case, diffuse abdominal thrombosis should be included as a diffrential diagnosis in a nephrotic patient with abdominal pain.