Nephrosis and clots

Article Outline

• Copyright

In the days before steroids and other drugs made childhood nephrotic syndrome (NS) controllable, thromboembolic disease was one of the major causes of death. Although older pediatric textbooks discuss this complication extensively, the association is often forgotten today, especially by primary care providers.

In the current issue of The Journal, Kerlin et al mined the records of two major pediatric centers in Columbus, Ohio and Ann Arbor, Michigan, to establish how much of a problem thromboembolic complications present to patients with NS today. Although, fortunately and commendably, there was no mortality in their series of 326 children, nearly 10% of them had some evidence of thromboembolic disease during their course. Risk factors included older (>12 years) age, severe proteinuria, and prior history of thrombosis. Primary care providers should be aware that many of these complications occurred very early in the course of the NS--potentially before nephrology consultation had been obtained. This is certainly the case for the 4 children, in whom thromboembolic complications were present at the time of diagnosis of NS.

Article page 105 ▸