Abstract
Anticoagulant therapy is a very important strategy for children with nephrotic syndrome, because of their hyper-coagulated condition. For patients with steroid-resistant nephrotic syndrome who show poor response to initial steroid treatment, renal biopsy is preferably required for diagnosis and treatment. At the time of renal biopsy, however, anticoagulant therapy is usually discontinued to reduce the hemorrhagic risk for those with steroid-resistant nephrotic syndrome. In addition, it has been stated that children with steroid-resistant nephrotic syndrome have usually hypercoagulation state.
We here report a 6-year-old boy with steroid-resistant nephrotic syndrome who developed deep venous thrombosis (DVT) in his left subclavian vein after renal biopsy. He needed the central venous catheter, because of the difficulty of blood drawing and establishment of an intravenous line for severe edema. At renal biopsy temporal discontinuation of anticoagulant therapy resulted in the production of DVT in his left subclavian vein. We immediately started warfarin administration and checked the affected vein periodically with vein echogram. DVT gradually disappeared and blood flow was finally reconstituted two months later.
We can conclude that for steroid-resistant nephrotic syndrome, the usage of the anticoagulation therapy and central venous catheter should be carefully considered to prevent the deep venous thrombosis, especially at the time of renal biopsy.
