BOF: 41
A 24-year-old male is admitted with a history of swelling
of his lower limbs and facial swelling. On examination he has pitting oedema
of his lower limbs and swelling of his eyelids. Blood pressure 130/80
Urinalysis:
Protein ++++
Blood negative
Investigations:
Sodium 138 mmol/L
Potassium 4.5 mmol /L
Urea 8.4 mmol/L
Creatinine 107 mmol/L
Albumin 21 g/L
24-hour urine protein 5.2 g
Renal biopsy show normal appearances on light microscopy.
Electron microscopy shows podocyte effacement
The patient is treated with steroids and diuretics
A week later the patient complains of pain in his loins
Repeat investigations show
Urine
Protein ++++
Blood +++
Blood
Urea 32 mmol /L
Creatinine 200 mmol/L
In this patient which of the following is most likely to
reduce the cause of the complication that has occurred?
a)
ACE inhibitor
b)
Loop diuretic
c)
Aldosterone antagonist
d)
High protein diet
e)
Dialysis
Answer: a)
The patient has nephrotic syndrome
Loin pain, haematuria and deteriorating renal function in
a patient who is known to have nephrotic syndrome would suggest that the
patient has developed the complication of renal vein thrombosis
This is mainly due to secondary antithrombin III
deficiency
Medical treatment of renal vein thrombosis consists of:
·
Treat nephrotic syndrome
Steroids
Immunosuppression
·
Angiotensin-converting enzyme inhibitors (ACEIs) and or
angiotensin II receptor blockers (ARBs) to decrease proteinuria from nephrotic
syndrome
Decreasing protein loss in the urine decreases hypercoagulability
·
Anticoagulation with warfarin
Prophylaxis against pulmonary embolism
·
Atorvastatin
Decreases the rate of progression of kidney
disease, proteinuria, and hypercholesterolemia
Revision Tip
Revise nephrotic syndrome KEYS
to SUCCESS in Medicine page 319-321
