Pulmonary embolism and renal vein thrombosis in patients with nephrotic syndrome: Prospective evaluation of prevalence and risk factors with CT

Long Jiang Zhang, Zhuoli Zhang, Shi Jun Li, Felix G. Meinel, John W. Nance, Chang Sheng Zhou, Yan E. Zhao, U. Joseph Schoepf, Guang Ming Lu

Research output: Contribution to journalArticle

35 Scopus citations

Abstract

Purpose: To prospectively determine the prevalence of pulmonary embolism (PE) and renal vein thrombosis (RVT) with computed tomography (CT) and to identify markers predictive of PE and/or RVT in a large consecutive cohort of patients with nephrotic syndrome.

Materials and Methods: This study was approved by the local institutional review board, and all patients or their guardians provided written informed consent. Consecutive patients with nephrotic syndrome (24-hour urine protein > 3.5 g) underwent combined CT pulmonary angiography for PE and renal CT venography for RVT. Prevalence of PE and/or RVT was estimated for different ages, sexes, and histopathologic types of nephrotic syndrome. Multivariate analysis was used to determine independent predictors for PE and/or RVT in patients with nephrotic syndrome.

Results: There were 512 patients in the study cohort (331 male patients, 181 female patients; mean age, 37 years ± 17 [standard deviation]; range, 9-81 years), including 80 children. One hundred eighty (35%) of 512 patients had PE and/or RVT, with PE the more common condition (85% [153 of 180]). PE was associated with RVT in 85 (56%) of 153 patients and was isolated in 68 patients (44%). Most patients with PE (84% [128 of 153]) were asymptomatic. One hundred twelve (22%) of 505 patients had RVT. PE and/or RVT was found in 15 (19%) of 80 children with nephrotic syndrome, while 165 (38%) of 432 adult patients with nephrotic syndrome had PE and/or RVT (P = .001). Membranous nephropathy was the most common histopathologic type associated with PE and/or RVT (48% [88 of 183]). Membranous nephropathy, age greater than 60 years, high hemoglobin level, long prothrombin time, and high creatinine level were independent predictors of PE and/or RVT (P < 05 for all).

Conclusion: PE and RVT are common in patients with nephrotic syndrome. PE is more common than RVT, is most often asymptomatic, and is most frequently found in patients with membranous nephropathy. A high index of suspicion and a low threshold for diagnostic work-up is warranted in these patients.

Original languageEnglish (US)
Pages (from-to)897-906
Number of pages10
JournalRadiology
Volume273
Issue number3
DOIs
StatePublished - Dec 1 2014

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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