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 Table of Contents  
LETTER TO EDITOR
Year : 2016  |  Volume : 4  |  Issue : 2  |  Page : 96

Pulmonary embolism as the primary presenting feature of nephrotic syndrome


Department of Paediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad, Iraq

Date of Web Publication10-Jun-2016

Correspondence Address:
Mahmood Dhahir Al-Mendalawi
Department of Paediatrics, Al-Kindy College of Medicine, Al-Nahda Square, Baghdad
Iraq
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2320-8775.183835

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How to cite this article:
Al-Mendalawi MD. Pulmonary embolism as the primary presenting feature of nephrotic syndrome. J Assoc Chest Physicians 2016;4:96

How to cite this URL:
Al-Mendalawi MD. Pulmonary embolism as the primary presenting feature of nephrotic syndrome. J Assoc Chest Physicians [serial online] 2016 [cited 2021 Dec 7];4:96. Available from: https://www.jacpjournal.org/text.asp?2016/4/2/96/183835

Dear Sir,

I read with interest the case report by Periwal et al. on pulmonary embolism (PE) as the primary presenting feature of nephrotic syndrome (NS).[1] The case in question could be confidently added to the increasing number of similar cases reported in the literature.[2],[3] Apart from increasing alertness of the clinicians on PE as an initial presentation of NS, I presume the case in question has indirectly sent another sound clinical message. It is well-known that proteinuria is a marker of chronic kidney diseases. The available data have pointed out that about those who did not have proteinuria, patients who tested positive for protein had a 3.4-fold increased risk of venous thromboembolism (VTE) (odds ratio 3.4, 95% confidence interval [2.4, 5.0]). Such association was found to be unchanged when adjusted for other risk factors.[4] In an interesting American study, the electronic medical records were retrospectively reviewed to measure the percentage of patients with acute VTE, who had a urinalysis (UA) and/or an evaluation of 24 h urine protein collection or urine protein to creatinine ratio. The study showed that UA was done in 63% of patients on the same admission for VTE and in the remaining 26% at a later date. Proteinuria, on routine urinalysis, was identified in 54% of patients. However, only 19% of these patients with proteinuria on UA had a formal evaluation of urine protein excretion, either by 24 h collection or by spot protein to creatinine ratio. Among them, 28% had NS. The study concluded that patients suffering from VTE might have proteinuria if not frank NS.[5] Therefore, it has been recommended that UA should be part of the routine evaluation of a patient with VTE to disclose underlying proteinuria and even NS.[5] Similarly, I presume that the take-home message sent by the case in question was simply “don't forget to dip the urine in a patient with PE.”

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Periwal P, Khanna A, Nair V, Talwar D. Pulmonary embolism as the primary presenting feature of nephrotic syndrome. J Assoc Chest Physicians 2016;4:15-7.  Back to cited text no. 1
  Medknow Journal  
2.
Ambler B, Irvine S, Selvarajah V, Isles C. Nephrotic syndrome presenting as deep vein thrombosis or pulmonary embolism. Emerg Med J 2008;25:241-2.  Back to cited text no. 2
    
3.
Chaudesaygues E, Grasse M, Marchand L, Villar E, Aupetit JF. Nephrotic syndrome revealed by pulmonary embolism: About four cases. Ann Cardiol Angeiol (Paris) 2014;63:385-8.  Back to cited text no. 3
    
4.
Kato S, Chernyavsky S, Tokita JE, Shimada YJ, Homel P, Rosen H, et al. Relationship between proteinuria and venous thromboembolism. J Thromb Thrombolysis 2010;30:281-5.  Back to cited text no. 4
    
5.
Htike N, Superdock K, Thiruveedi S, Surkis W, Teehan G. Evaluating proteinuria and nephrotic syndrome in patients with venous thromboembolism. Am J Med Sci 2012;343:124-6.  Back to cited text no. 5
    




 

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