The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지

A Case of Membranous Glomerulonephritis Presenting with Right Common Iliac Artery Thrombosis as the Initial Sign

우측 총장골동맥 혈전증이 초기 증상으로 발현된 막성 사구체신염 1예

  • Kim, Ji-Woon (Department of Internal Medicine, Bundang CHA Medical Center, CHA University) ;
  • Park, Hyun-Jung (Department of Internal Medicine, Bundang CHA Medical Center, CHA University) ;
  • Park, Ji-Soo (Department of Internal Medicine, Bundang CHA Medical Center, CHA University) ;
  • Oh, Ji-Su (Department of Internal Medicine, Bundang CHA Medical Center, CHA University) ;
  • Kim, Jo-Eun (Department of Internal Medicine, Bundang CHA Medical Center, CHA University) ;
  • Oh, Hyun-Ju (Department of Internal Medicine, Bundang CHA Medical Center, CHA University) ;
  • Kim, Hyung-Jong (Department of Internal Medicine, Bundang CHA Medical Center, CHA University)
  • 김지운 (CHA의과학대학교 분당차병원 내과학교실) ;
  • 박현정 (CHA의과학대학교 분당차병원 내과학교실) ;
  • 박지수 (CHA의과학대학교 분당차병원 내과학교실) ;
  • 오지수 (CHA의과학대학교 분당차병원 내과학교실) ;
  • 김조은 (CHA의과학대학교 분당차병원 내과학교실) ;
  • 오현주 (CHA의과학대학교 분당차병원 내과학교실) ;
  • 김형종 (CHA의과학대학교 분당차병원 내과학교실)
  • Published : 2011.08.01
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Abstract

Most patients with nephrotic syndrome visit the hospital because of edema due to hypoalbuminemia induced by severe proteinuria. However, rare cases have reported arterial thrombosis as the main problem complicating nephrotic syndrome. Arterial thrombosis combined with nephrotic syndrome is rarer than venous thrombosis, and it usually develops during treatment with steroids or diuretics. Arterial thrombosis is rarely diagnosed as the initial sign of nephrotic syndrome. We report the case of a 38-year-old-woman with membranous glomerulonephritis presenting with right common iliac artery thrombosis as the initial sign.

본 증례는 우측 하지통증을 주소로 내원한 하지동맥 혈전증 환자에 신장 조직 검사에서 막성 사구체신염이 진단된 경우로 막성 사구체신염에서도 초기 증상으로 하지동맥 혈전증이 나타날 수 있으며, 동맥 혈전증 발생 기전으로 antithrombin III, fibrinogen 등의 혈액응고인자 이상 및 저알부민혈증뿐만 아니라 MTHFR C677T mutation과 같은 유전적인 요인도 관여할 것으로 생각되어 향후 연구가 필요할 것으로 생각된다.

Keywords

References

  1. An YJ, Na JI, An JH, et al. A successful thrombolytic therapy in the thrombosis of right common lilac artery complicated from minimal change Nephrotic syndrome. Korean J Nephrol 1992;11:167-172.
  2. Kim YK, Choi DW, Han JS, et al. Arterial thromboses in Nephrotic syndrome. Korean J Nephrol 1987;6:153-159.
  3. Hong HS, Choi SO, Shin SJ, et al. A case of arterial thrombosis as a first manifestation of Nephrotic syndrome. Korean J Nephrol 1994;13:187-190.
  4. Huang JB, Yang WC, Yang AH, Lee PC, Lin CC. Arterial thrombosis due to minimal change glomerulopathy secondary to nonsteroidal anti-inflammatory drugs. Am J Med Sci 2004;327:358-361. https://doi.org/10.1097/00000441-200406000-00012
  5. Kwon HJ, Park IW, Cho HK, Yoon SY. A case of minimal change disease presenting bilateral popliteal arterial thrombosis. Korean J Nephrol 2006;25:467-471.
  6. Llach F, Papper S, Massry SG. The clinical spectrum of renal vein thrombosis: acute and chronic. Am J Med 1980;69:819-827. https://doi.org/10.1016/S0002-9343(80)80006-4
  7. Kim HJ, Park CH, Kang CM, Park HC, Kim CY, Cho YS. Arterial thrombosis associated with Nephritic syndrome-a case report and review (adult cases in the English literature). J Korean Med Sci 1993;8:230-234.
  8. Nachman RL, Silverstein R. Hypercoagulable states. Ann Intern Med 1993;119:819-827. https://doi.org/10.7326/0003-4819-119-8-199310150-00008
  9. Llach F. Thromboembolic complication in nephrotic syndrome: coagulation abnormalities, renal vein thrombosis, and other conditions. Postgrad Med 1984;76:111-114, 116-118, 121-123.
  10. Nishimura M, Shimada J, Ito K, Kawachi H, Nishiyama K. Acute arterial thrombosis with antithrombin III deficiency in Nephrotic syndrome: report of a case. Surg Today 2000;30:663-666. https://doi.org/10.1007/s005950070110
  11. Bang NU, Trygstad W, Schroeder JE, Heidenreich RO, Csiscko BM. Enhanced platelet function in glomerular renal disease. J Lab Clin Med 1973;81:651-660.
  12. Dahlback B. Inherited thrombophilia: resistance to activated protein C as a pathogenic factor of venous thromboembolism. Blood 1995;85:607-614.
  13. Kearon C. Epidemiology of venous thromboembolism. Semin Vasc Med 2001;1:7-26. https://doi.org/10.1055/s-2001-14668
  14. Buyukcelik M, Karakok M, Baspinar O, Balat A. Arterial thrombosis associated with factor V Leiden and methylene tetrahydrofolate reductase C677T mutation in childhood membranous glomerulonephritis. Pediatr Nephrol 2008;23:491-494. https://doi.org/10.1007/s00467-007-0657-1
  15. Sontheimer DL. Peripheral vascular disease: diagnosis and treatment. Am Fam Physician 2006;73:1971-1976.