Risk factors of venous thromboembolism in focal segmental glomerulosclerosis with nephrotic syndrome.

BACKGROUND: Venous thromboembolism (VTE) is an important and potentially life-threatening complication in focal segmental glomerulosclerosis (FSGS). The aim of this study was to investigate the prevalence and predisposing risk factors of venous thromboembolism in patients with FSGS with nephrotic syndrome. METHODS: A total of 120 FSGS patients with nephrotic syndrome were enrolled in this study. Venous thromboembolism was confirmed by contrast-enhanced dual-source computed tomography angiography or magnetic resonance venography. Potential clinical and laboratory risk factors for VTE were screened. RESULTS: Venous thrombosis was demonstrated in 12 (10 %) patients. Venous thrombosis occurred during the first episode of nephrotic syndrome in 3 patients and during a relapse in 9 patients. Eight patients had a pulmonary embolism, four had a renal vein thrombosis, three had a lower limb deep vein thrombosis, one had a cerebral sinovenous thrombosis, and one had a portal vein thrombosis. The positive predictive value for the D-dimer level was 22.4 % in the patients with FSGS, and the negative predictive value for the D-dimer level was 100 %. Of the screened risk factors, higher hematocrit and relapse of nephrotic syndrome were risk factors for VTE. Other risk factors, such as proteinuria, hypoalbuminemia, platelet count, fibrinogen level, and antithrombin III level, were not risk factors for VTE in patients with FSGS. CONCLUSION: We found that the prevalence of venous thromboembolism is approximately 10 % in FSGS patients with nephrotic syndrome. Most of the patients had a PE. Hemoconcentration and relapse of nephrotic syndrome were risk factors for the development of VTE in FSGS. Negative D-dimer may exclude venous thromboembolism in patients with nephrotic syndrome.

Renal involvement in non-Hodgkin lymphoma: proven by renal biopsy.

AIMS: To determine the spectrum of renal lesions in patients with kidney involvement in non-Hodgkin's lymphoma (NHL) by renal biopsy. METHODS: The clinical features and histological findings at the time of the renal biopsy were assessed for each patient. RESULTS: We identified 20 patients with NHL and renal involvement, and the diagnosis of NHL was established following the kidney biopsy in 18 (90%) patients. The types of NHL include the following: chronic lymphocytic leukemia/small lymphocytic lymphoma (n = 8), diffuse large B-cell lymphoma (n = 4), T/NK cell lymphoma (n = 3), lymphoplasmacytic lymphoma (n = 2), cutaneous T-cell lymphoma (n = 1), mucosa-associated lymphoid tissue lymphoma (n = 1) and mantle cell lymphoma (n = 1). All presented with proteinuria, and 15 patients had impaired renal function. The pathological findings included (1) membranoproliferative glomerulonephritis-like pattern in seven patients; (2) crescent glomerulonephritis in four; (3) minimal-change disease in three, and glomeruli without specific pathological abnormalities in three; (4) intraglomerular large B-cell lymphoma in one; (5) intracapillary monoclonal IgM deposits in one; (6) primary diffuse large B-cell lymphoma of the kidneys in one; and (7) lymphoma infiltration of the kidney in eight patients. CONCLUSION: A wide spectrum of renal lesions can be observed in patients with NHL, and NHL may be first proven by renal biopsies for evaluation of kidney injury or proteinuria. Renal biopsy is necessary to establish the underlying cause of renal involvement in NHL.