Abstract
Minimal change disease (MCD) is a well-known cause of fulminant acute nephrotic syndrome
(NS) and has been associated with thrombotic complications. We report the case of
a 51-year-old woman with previous biopsy-proven MCD in remission who presented with
worsening headache and acute confusion shortly after a relapse of the NS and was diagnosed
with cerebral venous thrombosis (CVT) complicated by intracranial hemorrhage and midline
shift. One month prior, she had been initiated on an oral contraceptive agent during
remission of the NS. After initiation of systemic anticoagulation, her condition rapidly
deteriorated, and she passed away before being able to undergo catheter-based venous
thrombectomy. We conducted a systematic literature review and identified 33 case reports
of adults with NS-associated CVT. The most common symptoms were headache (83%), nausea
or vomiting (47%), and altered mental status (30%). 64% of patients presented at time
of initial diagnosis of the NS and 32% during a relapse. Mean urinary protein excretion
was 9.32 g/day and mean serum albumin was 1.8 g/dL. 91% of patients received systemic
anticoagulation, and 19% died. The outcome in the remaining cases was favorable with
only one report (5%) of residual neurological deficit. Of the available kidney biopsy
results, MCD was the most common diagnosis (70%), raising the hypothesis that the
fulminant acute onset of the NS might be a predisposing factor for this serious thrombotic
complication. Clinicians should have a high index of suspicion for CVT in patients
with the NS who present with new-onset neurological symptoms, including headache and
nausea.
Key Indexing Terms
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Article info
Publication history
Published online: March 16, 2023
Accepted:
March 10,
2023
Received:
September 15,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
