A case of pulmonary embolism in nephrotic syndrome with mild hypoalbuminemia

Abstract

Hypoalbuminemia is associated with the increased risk of thromboembolic complications in patients with the nephrotic syndrome. We report a case of a 13-year-old boy who was suggested proteinuria in a school urinary screening program, the serum albumin level was 2.7 g/dl and the urinary protein-to-creatinine ratio (UP/Cr) was 2.4 g/gCr at the admission. Five days later, he was diagnosed the nephrotic syndrome because the serum albumin level decreased to 2.5 g/dl. He received prednisolone (60 mg/day), and reached to remission on day 12 of hospitalization. There was hypercoagulable state such as FDP 9.0 μg/ml at the admission, and hypercoagulability was not improved after remission. There were no congenital thrombotic factor and antiphospholipid syndrome, but FDP increased to 13.2 μg/ml, and the platelet count also decreased to 13×10⁴/μl on day 32 of hospitalization. A contrast-enhanced CT scan demonstrated bilateral pulmonary embolisms. Anticoagulant therapy with warfarin was stared, with dose adjustment according to PT values. Finally pulmonary embolisms were resolved without sequelae. In children with the nephrotic syndrome, we should carefully consider thrombosis and check the imaging test when hypercoagulability is not improved, even if low serum albumin levels are not severe.