Clinical Analysis Of Primary Nephrotic Syndrome With Arterial And Venous Thromboembolism

Objective: The study mainly studied the arterial and venous thromboembolic events of primary nephrotic syndrome,explored the risk factors of these events and the characteristics of thrombus distribution,and summarized the clinical features.Methods: Patients who were diagnosed with PNS complicated by thromboembolism(TE)in the Department of Nephrology,the Second Hospital of Hebei Medical University from January 1,2018 to December 31,2020,were included in the TE group,and they were divided into the ATE group and the VTE group according to the location of thrombosis.T-test and Logistic regression analysis were performed on the collected clinical data,to explore the clinical features and risk factors of thromboembolic events in PNS.Results:1.The study included a total of 117 patients in the TE group,34 patients in the ATE group and 92 patients in the VTE group.Among them,9 patients had arterial and venous thrombotic events simultaneously.2.In general data,the male ratio and age of the TE group were higher than those of the control group.We compared the pathological results in the TE group,among them 65 cases(77%)of membranous nephropathy(MN),13cases(18%)of minimal change disease(MCD),3 cases(3%)of Ig A nephropathy(Ig AN),1 case each(1%)of focal segmental glomerulosclerosis(FSGS),and mesangial proliferative glomerulonephritis(Ms PGN).In the control group,17 cases(71%)were MN,2 cases(17%)of MCD,1 case each(4%)of Ig AN,FSGS,Ms PGN.3.The thrombus distribution in the ATE group and the VTE group was counted.The ATE group includes coronary heart disease(CHD,17 cases),ischemic stroke(IS,15 cases)and others(2 cases,including 1 case of superior mesenteric arterial and left common iliac arterial embolism,1 case of abdominal aortic embolism).There were 77 cases of deep venous thrombosis(DVT)in the VTE group,followed by 10 cases of pulmonary embolism(PE),10 cases of renal vein thrombosis(RVT),5 cases of inferior vena cava thrombosis,1 case of venous sinus(superior sagittal sinus)thrombosis,and 1case of upper limb(axillary vein)venous thrombosis.Venous thrombosis in multiple sites occurred in 12 patients;arterial and venous thromboembolism occurred in 9 patients simultaneously.4.Both ATE and VTE had the highest incidence in the first half year of the disease course,with 44.1% and 51.1% respectively,followed by the course of disease within 6 months to 1 year,with 23.5% and 27.2% respectively.5.Compared with the clinical data,the CHOL and LDL of the ATE group were lower than those of the control group,and the LDH,SCr,FDP,and D-Dimer were higher than those of the control group.Logistic regression analysis showed that ALB and SCr were independent risk factors for PNS complicated with ATE.The LDH,SCr,FDP,D-Dimer of the VTE group were higher than those of the control group,and the serum ALB was lower than the control group,and the difference was statistically significant.Logistic regression analysis showed that age and D-Dimer were independent risk factors for PNS complicated with VTE.Conclusions:1.In this study,MN was the most common pathological type of PNS complicated by thromboembolism,followed by MCD.2.The incidence of VTE is higher than that of ATE.DVT is the most common site of thromboembolism,followed by CHD,IS,PE and RVT.3.Both ATE and VTE mostly occur in the first half year of the course of nephrotic syndrome.4.Hypoalbuminemia and high serum creatinine are related to PNS complicated by ATE;advanced age and high D-dimer level are related to PNS complicated by VTE.