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Xue H, Xue K, Wang X, Xu W, Zhang W, Xia G. Chronic subdural hematoma that may be caused by nephrotic syndrome: a case report and literature review. Front Neurol 2024; 15:1454361. [PMID: 39239394 PMCID: PMC11375511 DOI: 10.3389/fneur.2024.1454361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 07/29/2024] [Indexed: 09/07/2024] Open
Abstract
Background Chronic subdural hematoma (CSDH) is a common complication of neurosurgery. Craniocerebral trauma is the likely cause. There are no reports relating CSDH with nephrotic syndrome. Its pathogenesis is very rare, and there are no previous reports on treatments for this disease. We report a case of chronic subdural hematoma that may be caused by nephrotic syndrome and review the previous literature on this subject. Case summary We report a rare case of chronic subdural hematoma that may be caused by nephrotic syndrome. After the patient was admitted to the hospital, relevant laboratory tests were conducted, and a large amount of protein was detected in the patient's urine, indicating hypoproteinaemia and hyperlipidemia. The patient was diagnosed with nephrotic syndrome. After the exclusion of related surgical contraindications, the patient underwent trepanation and drainage of the chronic subdural hematoma. Subsequent treatment with oral atorvastatin was provided after surgery. The patient was transferred to the nephrology department for further treatment of nephrotic syndrome if his neurological condition improved. No neurological sequelae were detected at the follow-up visit 3 months after the operation. Conclusion Chronic subdural hematomas are rarely caused by nephrotic syndrome. Trepanation and drainage may be considered for patients confirmed to have adequate hematoma liquefaction on imaging and who can tolerate craniotomy. Atorvastatin should be supplemented as prophylactic treatment after the operation. Nephrotic syndrome should be treated as soon as the patient's neurological condition is stable.
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Affiliation(s)
- Hang Xue
- Department of Neurosurgery, Yantaishan Hospital Affiliated to Binzhou Medical University, Yantai, Shandong, China
| | - Kun Xue
- Department of Neurosurgery, Yantaishan Hospital Affiliated to Binzhou Medical University, Yantai, Shandong, China
| | - Xiaohui Wang
- Department of Nephrology, Yantaishan Hospital Affiliated to Binzhou Medical University, Yantai, Shandong, China
| | - Weidong Xu
- Department of the First Neurosurgery, The First Affiliated Hospital of Henan Polytechnic University, Jiaozuo, Henan, China
| | - Weitao Zhang
- Department of Neurotraumatic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Guangwen Xia
- Department of Neurosurgery, Yantaishan Hospital Affiliated to Binzhou Medical University, Yantai, Shandong, China
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Characteristics of ischemic stroke and intracranial hemorrhage in patients with nephrotic syndrome. BMC Nephrol 2021; 22:213. [PMID: 34090375 PMCID: PMC8178873 DOI: 10.1186/s12882-021-02415-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 05/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The incidence of cerebral stroke, including ischemic infarction and intracranial hemorrhage (ICH), increases in patients with nephrotic syndrome (NS). However, the clinical characteristics of patients with NS and stroke remain elusive. We aimed to investigate the clinical presentation and prognosis among patients with NS and ischemic stroke (IS) or ICH. METHODS We conducted a population-based retrospective cohort study of patients with NS and acute stroke using the Chang Gung Research Database of Taiwan from January 1, 2001, to December 31, 2017. The participants were recruited from the 7 branches of Chang Gung Memorial Hospital. RESULTS A total of 233 patients with IS and 57 patients with ICH were enrolled. The median age was 60 (52-70) years. The prevalence rates of hyperlipidemia, hyperuricemia, and smoking were higher in IS than in ICH. IS demonstrated lower white blood cell count (7.80 vs. 8.92 × 109/L) and high-sensitivity C-reactive protein level (33.42 vs. 144.10 nmol/L) and higher cholesterol (5.74 vs. 4.84 mmol/L), triglyceride (1.60 vs. 1.28 mmol/L), and albumin (24 vs. 18 g/L) levels compared with ICH. The dependent functional status and 30-day mortality were higher in ICH than in IS. The risk factors for 30-day mortality for patients with NS and stroke were coronary artery disease (CAD), ICH, and total anterior circulation syndrome. The multivariate Cox regression analysis revealed that CAD was positively associated with 30-day mortality in patients with IS (hazard ratio 24.58, 95 % CI 1.48 to 408.90). In patients with ICH, CAD and subarachnoid hemorrhage were positively associated with 30-day mortality (hazard ratio 5.49, 95 % CI 1.54 to 19.56; hazard ratio 6.32, 95 % CI 1.57 to 25.53, respectively). CONCLUSIONS ICH demonstrated a higher risk of dependence and 30-day mortality compared with IS in patients with NS. Intensive monitoring and treatment should be applied particularly in patients with NS and ICH.
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Vos E, Koster-Kamphuis L, van de Kar NCAJ, Bootsma-Robroeks CMHHT, Cornelissen EAM, Schreuder MF. Preparing for a kidney transplant: Medical nephrectomy in children with nephrotic syndrome. Pediatr Transplant 2020; 24:e13703. [PMID: 32212310 DOI: 10.1111/petr.13703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 10/25/2019] [Accepted: 02/10/2020] [Indexed: 11/30/2022]
Abstract
Nephrotic syndrome is characterized by proteinuria, hypoalbuminemia, and general edema. These symptoms may persist in children who reach ESRD, which is unfavorable for the patient's allograft outcome. In addition, this may hamper early diagnosis of a relapse after transplantation. Surgical bilateral nephrectomy is often considered for that reason, but medical nephrectomy may be a less invasive alternative. In this retrospective single-center case series, we identified all children on dialysis with ESRD due to nephrotic syndrome in which a medical nephrectomy was attempted before kidney transplantation between 2013 and 2018. Outcome was measured by urine output and serum albumin levels. Eight patients with either congenital nephrotic syndrome or focal segmental glomerular sclerosis were included in the study. All patients received an ACE inhibitor as drug of first choice for medical nephrectomy, to which 5 patients responded with oligoanuria and a significant rise in serum albumin, and 3 patients responded insufficiently. In 1 of these 3 patients, diclofenac was added to the ACE inhibitor, with good result. In the other 2 patients, indomethacin was initiated without success, and surgical bilateral nephrectomy was performed. Overall, 6/8 patients had a successful medical nephrectomy and did not need surgical nephrectomy. No recurrence of nephrotic syndrome was found after kidney transplantation in all but one. Medical nephrectomy with ACE inhibitors and/or non-steroidal anti-inflammatory drugs is a safe and non-invasive therapy to minimize proteinuria in children with ESRD due to nephrotic syndrome before kidney transplantation. We suggest that this strategy should be considered as therapy before proceeding with surgical nephrectomy.
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Affiliation(s)
- Eefke Vos
- Department of Pediatric Nephrology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Linda Koster-Kamphuis
- Department of Pediatric Nephrology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicole C A J van de Kar
- Department of Pediatric Nephrology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Elisabeth A M Cornelissen
- Department of Pediatric Nephrology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michiel F Schreuder
- Department of Pediatric Nephrology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
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Yang M, Pan X, Liang Z, Huang X, Duan M, Cai H, Yu L, Chen L. Clinical Features of Nephrotic Syndrome with Cerebral Hemorrhage. Med Sci Monit 2019; 25:2179-2185. [PMID: 30904921 PMCID: PMC6442498 DOI: 10.12659/msm.912466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Cerebral hemorrhage has been increasingly reported in patients with nephrotic syndrome (NS). However, the clinical features and pathogenesis of NS patients with cerebral hemorrhage remain unclear. Material/Methods From January 2007 to August 2017, continuous NS patients with cerebral hemorrhage at the First Affiliated Hospital of Guangxi Medical University were selected. The clinical manifestations, laboratory measurements, and neurological images of these patients were collected and analyzed. Results Acute cerebral hemorrhage was recorded in 15 of 10 461 NS patients. The average age of these 15 patients (9 males and 6 females) was 50.87±23.27 years old. Among these 15 patients, conventional vascular risk factors were identified in 8 patients, hypoalbuminemia and proteinuria were recorded in all 15 patients, coagulopathy was observed in 9 patients, increased D-dimer level was recorded in 13 patients, hyperlipidemia was recorded in 11 patients, and impaired renal function was recorded in 9 patients. The hemorrhage developed in the lobe (n=9), basal ganglia (n=3), cerebellum (n=2), and cerebral hemisphere (n=1). Eight patients were in a coma on the day the cerebral hemorrhage occurred, while 12 patients had a poor prognosis after 30 days of hemorrhage onset. Conclusions Poor prognosis was recorded in NS patients with cerebral hemorrhage. Although conventional vascular risk factors have only been identified in 8 patients, biochemical abnormalities (hypoalbuminemia, proteinuria, elevated D-dimer, and hyperlipidemia) were recorded in the majority of these 15 patients. Furthermore, most of the hemorrhages developed in the lobes. Coagulopathy might be the potential pathogenesis of cerebral hemorrhage in NS patients.
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Affiliation(s)
- Mengqi Yang
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Xueying Pan
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Zhijian Liang
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Xiaoqin Huang
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Meiyi Duan
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Hui Cai
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Lixia Yu
- Medical Records Room, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Li Chen
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
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Radiologically Guided Renal Artery Embolization with an Amplatzer Vascular Plug as a Rescue Therapy for Refractory Nephrotic Syndrome in AL-Amyloidosis. Case Rep Nephrol 2019; 2019:5469712. [PMID: 30886753 PMCID: PMC6388347 DOI: 10.1155/2019/5469712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/23/2019] [Indexed: 12/02/2022] Open
Abstract
Nephrotic syndrome is common in immunoglobulin light-chain (AL) amyloidosis and successful therapy may pose a challenge. We report the case of a 63-year-old patient with severe nephrotic syndrome due to primary renal AL-amyloidosis with well-preserved renal function at first presentation. Therapy with high dose steroids, loop diuretics, and ACE-inhibitors did not affect his proteinuria and he was seriously disabled because of symptomatic orthostatic hypotension and anasarca. With the patient's informed consent, medical nephrectomy was tried with nonsteroidal-anti-inflammatory drugs (NSAIDs), cyclosporine, and aminoglycosides, with significant deterioration of his renal function, but without relevant effect on his proteinuria. Despite adequate anticoagulation life threatening thrombotic and bleeding complications occurred. Total renal ablation was finally achieved using an Amplatzer vascular plug Typ IV (AVP 4) with a self-expanding Nitinol mesh design, which was placed in both main renal arteries in the same intervention. The patient became completely anuric, protein loss stopped, and serum albumin slowly rose to normal levels. The patient's clinical condition dramatically improved and he regained his full mobility at the price of a lifelong renal replacement therapy. To our knowledge, this is the first reported usage of such a vascular occluder in the setting of refractory nephrotic syndrome with normal kidney function at the time of first presentation.
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Küchlin S, Duffner J, Scheubeck S, Schoeller K, Maruschke L, Seidl M, Engelhardt M, Walz G, Prager EP, Waldschmidt JM. Kidney embolization induces prompt organ response in a 86‐year‐old patient with MGRS‐related AL‐amyloidosis. Hemodial Int 2018; 23:E59-E64. [DOI: 10.1111/hdi.12707] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Sebastian Küchlin
- Department of Medicine IVUniversity Medical Center, Faculty of Medicine, University of Freiburg Freiburg Germany
| | - Johannes Duffner
- Department of Medicine IVUniversity Medical Center, Faculty of Medicine, University of Freiburg Freiburg Germany
| | - Sophia Scheubeck
- Department of Hematology, Oncology and Stem Cell TransplantationFaculty of Medicine, University of Freiburg Freiburg Germany
| | - Katja Schoeller
- Department of Hematology, Oncology and Stem Cell TransplantationFaculty of Medicine, University of Freiburg Freiburg Germany
| | - Lars Maruschke
- Department of RadiologyUniversity Medical Center Freiburg Freiburg Germany
| | - Maximilian Seidl
- Institute for Surgical PathologyUniversity Medical Center Freiburg, Faculty of Medicine, University of Freiburg Freiburg Germany
| | - Monika Engelhardt
- Department of Hematology, Oncology and Stem Cell TransplantationFaculty of Medicine, University of Freiburg Freiburg Germany
| | - Gerd Walz
- Department of Medicine IVUniversity Medical Center, Faculty of Medicine, University of Freiburg Freiburg Germany
| | - Eric Peter Prager
- Department of Medicine IVUniversity Medical Center, Faculty of Medicine, University of Freiburg Freiburg Germany
| | - Johannes Moritz Waldschmidt
- Department of Hematology, Oncology and Stem Cell TransplantationFaculty of Medicine, University of Freiburg Freiburg Germany
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Abstract
Secondary, AA, amyloidosis is a rare systemic complication that can develop in any long-term inflammatory disorder, and is characterized by the extracellular deposition of fibrils derived from serum amyloid A (SAA) protein. SAA is an acute-phase reactant synthetized largely by hepatocytes under the transcriptional regulation of proinflammatory cytokines. The kidney is the major involved organ with proteinuria as first clinical manifestation; renal biopsy is the commonest diagnostic investigation. Targeted anti-inflammatory treatment promotes normalization of circulating SAA levels preventing amyloid deposition and renal damage. Novel therapies aimed at promoting clearance of existing amyloid deposits soon may be an effective treatment approach.
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Affiliation(s)
- Riccardo Papa
- Autoinflammatory Diseases and Immunodeficiencies Centre, Pediatric and Rheumatology Clinic, Giannina Gaslini Institute, University of Genoa, Via Gerolamo Gaslini 5, Genova 16147, Italy.
| | - Helen J Lachmann
- National Amyloidosis Centre, Royal Free Campus, University College Medical School, Rowland Hill Street, London NW3 2PF, UK
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Dogan N, Nas OF, Canver B, Ozturk K, Gokalp G. Selective bilateral renal artery embolization with tris-acryl microspheres in focal segmental glomerulosclerosis. Diagn Interv Imaging 2016; 98:277-278. [PMID: 27663140 DOI: 10.1016/j.diii.2016.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 06/18/2016] [Accepted: 06/20/2016] [Indexed: 12/14/2022]
Affiliation(s)
- N Dogan
- Radiology Clinic, Private Bahar Hospital, Bursa, Turkey.
| | - O F Nas
- Department of Radiology, Uludag University, Faculty of Medicine, Gorukle Campusu, 16059 Bursa, Turkey.
| | - B Canver
- Nephrology Clinic, Bursa State Hospital, Bursa, Turkey.
| | - K Ozturk
- Department of Radiology, Uludag University, Faculty of Medicine, Gorukle Campusu, 16059 Bursa, Turkey.
| | - G Gokalp
- Department of Radiology, Uludag University, Faculty of Medicine, Gorukle Campusu, 16059 Bursa, Turkey.
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Solak Y, Koc O, Ucar R, Ozbek O, Ergenc H, Gaipov A, Turk S. Renal artery embolization in severe nephrotic syndrome. Hemodial Int 2016; 20:407-13. [DOI: 10.1111/hdi.12397] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Yalcin Solak
- Nephrology Division, Department of Internal Medicine; Sakarya University Research and Training Hospital; Sakarya Turkey
| | - Osman Koc
- Department of Radiology; Necmettin Erbakan University, Meram School of Medicine; Konya Turkey
| | - Ramazan Ucar
- Department of Internal Medicine; Necmettin Erbakan University, Meram School of Medicine; Konya Turkey
| | - Orhan Ozbek
- Department of Radiology; Necmettin Erbakan University, Meram School of Medicine; Konya Turkey
| | - Hasan Ergenc
- Department of Internal Medicine; Sakarya University Research and Training Hospital; Sakarya Turkey
| | - Abduzhappar Gaipov
- Department of Extracorporeal Hemocorrection; National Scientific Medical Center; Astana Kazakhstan
| | - Suleyman Turk
- Nephrology Division, Department of Internal Medicine; Selcuk University; Konya Turkey
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Yeh CT, Tseng HS, Liu WS, Li SY, Yang WC, Ng YY. Severe proteinuria secondary to amyloidosis requiring bilateral renal artery embolization. CASE REPORTS IN NEPHROLOGY AND UROLOGY 2012. [PMID: 23197960 PMCID: PMC3482077 DOI: 10.1159/000339895] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In the case reported here, after prolonged medical therapy resistance, severe proteinuria subsided following bilateral renal artery embolization (RAE). Thereafter, respiratory distress, anasarca edema, muscle mass, and serum albumin level improved after regular hemodialysis. Although RAE is reported to be a safe and effective therapeutic procedure, it is rarely used for severe proteinuria with prolonged medical therapy resistance. The limited use of bilateral RAE for nephrological purposes may be partly related to its tendency to destroy renal function, which results in anuria and subsequent regular dialysis. However, delayed RAE could cause the patient to reach a life-threatening cachexic state and could increase the risk of morbidity and mortality due to severe proteinuria-induced hypoalbuminemia. Our case and selected previous reports reveal important information for physicians and patients while discussing prognoses and considering the pros and cons of bilateral RAE.
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Affiliation(s)
- Chun-Tung Yeh
- Department of Medicine, Ten-Chan General Hospital, Jhongli City, Taiwan, ROC
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Ozbek O, Acar K, Koc O, Saritas K, Toy H, Solak Y, Ozbek S, Kucukapan A, Guler I, Gaipov A, Turk S, Haznedaroglu IC. Short-Term Effects of Ankaferd Hemostat for Renal Artery Embolization: An Experimental Study. Cardiovasc Intervent Radiol 2012; 36:498-504. [DOI: 10.1007/s00270-012-0419-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 04/29/2012] [Indexed: 11/24/2022]
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12
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Keddis MT, Stegall MD, Textor SC. Renal ablation using bilateral ureteral ligation for nephrotic syndrome due to renal amyloidosis. Clin Kidney J 2012; 5:153-154. [PMID: 29497519 PMCID: PMC5783203 DOI: 10.1093/ndtplus/sfr160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Accepted: 10/31/2011] [Indexed: 12/03/2022] Open
Abstract
Nephrotic syndrome is common in immunoglobulin light chain amyloidosis (AL). In patients who do not achieve renal recovery, renal ablation has been reported for intractable proteinuria. We describe a patient with renal-limited AL who failed therapy and developed disabling proteinuria. He underwent laparoscopic ligation of the native ureters. Post-operatively, blood pressure improved. Hemodialysis was initiated. We conclude that bilateral ureteral ligation is a novel and minimally invasive method of renal ablation and may be considered for patients with refractory nephrotic syndrome.
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Affiliation(s)
- Mira T Keddis
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Mark D Stegall
- Division of Transplantation Surgery, Mayo Clinic, Rochester, MN
| | - Stephen C Textor
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
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Abstract
Systemic AA amyloidosis is a rare complication of chronic inflammatory disorders. The amyloid fibrils are derived from serum amyloid A protein, an acute phase protein synthesized in the liver. Clinical presentation is most commonly due to the consequences of renal involvement, with proteinuria and progressive renal decline. Progression to end stage renal failure is common. Management is currently centred on reducing the supply of the precursor protein by treating the underlying inflammatory condition, whilst supporting the affected organs. Monitoring of the serum amyloid A protein is vital to assess whether there is adequate suppression of the underlying disease. The level of serum amyloid A protein is a powerful predictor of both patient survival and renal outcome. In patients with adequate suppression of the serum amyloid A protein amyloid deposits can be seen to regress and renal function can be stabilised and even improve.
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