Pulmonary Embolism In Childhood Minimal Change Nephrotic Syndrome

ABSTRACT

PURPOSE:We investigated the incidence and predisposing factors of pulmonary embolism in minimal change nephrotic syndrome(MCNS). METHODS:Lung perfusion scan using 99mTC-MAA were done on 14 patients who were diagnosed to minimal change nephrotic syndrome. Group A; Five patients who had perfusion defects on scan, Group B; Nine patients who had no perfusion defect on scan. Between the two groups, the differences of platelet number, hematocrits, albumin, cholesterol, triglyceride, proteinuria were evaluated. RESULTS:Five patients were found to have perfusion defect consistent with pulmonary embolism(35.7%). However, there were minimal or no respiratory symptoms and signs. In our laboratory studies, the mean proteinuria on admissions was 676+/-31 mg/m2/hr in the group with pulmonary embolism, and 313+/-28 mg/m2/hr in the group without pulmonary embolism. There were more severe proteinuria in group with pulmonary embolism(P<0.05). The mean platelet count at early stage of remission after steroid treatment was 746,600+/-280,000/mm3 in the group with pulmonary embolism, 511,890+/-90,000/mm3 in the group without pulmonary embolism. There were significant difference of platelet count between the two groups(P<0.01). In patients with pulmonary embolism, there were more higher and sustained increasement of platelet count. All cases of pulmonary embolism were treated with dipyridamole(5 mg/kg). In 4 cases the perfusion defects were improved in two weeks, however, one case showed persistent perfusion defect after 1 month. CONCLUSION:Our study suggested that pulmonry embolism might be one of the major complications in childhood MCNS. The occurrence rate was correlated with severity of proteinuria before treatment and sustained increasement of platelet counts in early remission state after steroid treatment. Therefore, the scintigraphic pulmonary perfusion study is mandatory in childhood MCNS, especially in the high risk patients, such as the patients with severe proteinuria and sustained increasement of platelet count.