Abstract: TH-PO634

A Case of Dural Arteriovenous Fistula Caused by Dural Venous Sinus Thrombosis Complicated by Minimal Change Nephrotic Syndrome (MCNS)

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Yamashita, Risa, University of Miyazaki , Miyazaki, Japan
  • Ochiai, Shoko, University of Miyazaki , Miyazaki, Japan
  • Minakawa, Akihiro, University of Miyazaki , Miyazaki, Japan
  • Iwakiri, Takashi, University of Miyazaki , Miyazaki, Japan
  • Nishizono, Ryuzoh, University of Miyazaki , Miyazaki, Japan
  • Kikuchi, Masao, University of Miyazaki , Miyazaki, Japan
  • Nakagawa, Hideto, University of Miyazaki , Miyazaki, Japan
  • Sato, Yuji, University of Miyazaki , Miyazaki, Japan
  • Fujimoto, Shouichi, University of Miyazaki , Miyazaki, Japan
Background

Venous thrombosis is an important complication of nephrotic syndrome (NS). Dural sinus venous thrombosis is uncommon, but it is a major risk of dural arteriovenous fistula (DAF). We present a case of DAF due to dural venous thrombosis that was successfully treated by an intravascular approach.

Methods

A 78-year-old man was admitted to our hospital with a 1-week history of edema, weight gain, exertional dyspnea, and new-onset of disorientation. On admission, a urinary examination showed microscopic hematuria and heavy proteinuria (protein/creatinine ratio of 9.5 g/g creatinine). A blood examination showed an elevated blood urea nitrogen level of 24.3 mg/dL, creatinine level of 1.38 mg/dL, fibrinogen level of 352 mg/dL, D-dimer level of 21.6 µg/mL, and antithrombin-III was 57%. Additionally, serum albumin was reduced to 1.49 g/dL. His renal biopsy findings showed minor glomerular abnormalities. These findings were compatible with MCNS. Deep vein thrombosis of the right leg was found by echogram. Prednisolone, cyclosporine, and oral anticoagulant were administered. Despite proteinuria being reduced, his disorientation became worse daily. Head computed tomography showed a low-density area in his occipital lobes. Magnetic resonance imaging showed DAF with sigmoid sinus thrombosis in addition to cerebral venous reflux, micro-hemorrhages, and venous blood stasis. Thereafter, transcatheter embolization was performed on the 29th hospital day, and then his disorientation improved. He was discharged on the 42nd hospital day. At an 8-month follow-up, MCNS and DAF had not relapsed.

Conclusion

Hypoalbuminemia and reduced anticoagulant activity are considered as major risk factors for thrombosis in NS. When thrombus in the cranial sinus occurs, increased venous pressure may cause DAF, dural hypertension, or arterial steal, followed by neurological deficits. We describe the first case of NS that was complicated by disorientation due to DAF in association with dural sinus thrombosis.