Acute portal vein thrombosis at the onset of a nephrotic syndrome

Abstract

Thromboembolic events are common but serious complications of the nephrotic syndrome. Even if multiple studies failed to demonstrate a direct link between occurrence of these complications and haemostatic abnormalities, the nephrotic syndrome is characterized by a hypercoagulable state resulting to various extent from (i) thrombocytosis and platelet hyperaggregability, (ii) increased plasma levels of factors V and VIII, and of fibrinogen, (iii) decreased plasma levels of antithrombin III, free protein S, and protein C, and (iv) alterations in the fibrinolytic system [1-3]. The most common sites of thrombosis during adult nephrotic syndrome are deep veins of the lower limbs and renal veins, the latter being especially involved in membranous nephropathy. Morphological studies with Doppler ultrasonography and ventilation/perfusion isotope scanning reveal a higher incidence of thrombotic complications than expected from clinical studies with numerous patients being symptomless [4]. Arterial thrombosis affecting mesenteric, axillary, femoral, ophthalmic, renal, pulmonary, and coronary arteries has also been reported, but mainly in children. We describe here a case of portal vein thrombosis that occurred 9 days after the onset of a nephrotic syndrome in an adult patient. Only two cases of this unusual thrombotic complication of the adult nephrotic syndrome have been reported [5,6], and then only in relapsing patients.