Four-year-old boy that could not be lifesaving complicated with multiple venous thrombosis and intestinal necrosis in nephrotic syndrome

Abstract

Thromboembolism is one of the serious complications of pediatric idiopathic nephrotic syndrome (NS). We report the case of a 4-year-old boy suffering from steroid-resistant NS complicated with posterior reversible encephalopathy syndrome (PRES), acute kidney injury and multiple vein thrombosis. Although his symptoms with PRES subsequently improved by antihypertensive therapy, his renal dysfunction persisted requiring peritoneal dialysis. And then, intestinal thromboembolism caused sepsis and intestinal necrosis as a result. Despite thrombolytic and antibiotic therapy, his condition with sepsis and massive diarrhea caused by intestinal necrosis didn’t improve. Since his electroencephalogram suggested poor neurologic prognosis, we discontinued active treatments with fully informed consent of his parents and he died 93 days after onset. Adequate anticoagulation to prevent thromboembolism should be considered in treatment of the severe NS in children.