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Abstract: TH-PO513

Cerebral Venous Thrombosis in an Adult With Relapsing Minimal Change Disease: A Case Report and Literature Review

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

  • Bergmann, Matthias, Saint Elizabeth's Medical Center, Brighton, Massachusetts, United States
  • Segal, Christine, Saint Elizabeth's Medical Center, Brighton, Massachusetts, United States
  • Jaber, Bertrand L., Saint Elizabeth's Medical Center, Brighton, Massachusetts, United States
Introduction

Minimal change disease (MCD) is a well-known cause of fulminant nephrotic syndrome (NS) and associated with thrombotic events. Cerebral venous thrombosis (CVT) is a potentially fatal, albeit rare complication. We present a case of relapsing MCD complicated by CVT and intracranial hemorrhage (ICH), and provide a systematic review of cases with NS-associated CVT.

Case Description

A 51-year-old woman with biopsy-proven MCD in remission previously treated with glucocorticoids presented with headache, vomiting, and confusion after relapse of the NS. Proteinuria was 14.7 g/g creatinine and serum albumin was 2.5 g/dL. Brain MRI was consistent with CVT complicated by ICH. One month prior, she had been initiated on an oral combination contraceptive for menstrual cramps. She was treated with anticoagulation and glucocorticoids and died before being able to undergo catheter-based therapy.

Discussion

Our systematic review of 33 cases with NS-associated CVT is shown in Table 1. Average proteinuria was 9.32 g/day (0.05-24.30), and average serum albumin was 1.8 g/dL (0.7-3.6). 14 patients (70%) had MCD. Most reported symptoms were headache (83%), nausea/vomiting (47%), and altered mental status (30%). 5 patients (15%) developed ICH. 20 patients (91%) received anticoagulation and 5 patients (23%) underwent catheter-based therapies. 5 patients (19%) died from the sequelae of CVT, 3 of which (60%) had ICH.

In conclusion, MCD might be related to a higher risk of CVT due to its fulminant manifestation of the NS. Additional prothrombotic triggers, such as oral contraceptives, should be avoided. Neurological symptoms are often non-specific and threshold for MRI should be low in patients with the NS.

Table 1. Characteristics of 33 patients with nephrotic syndrome-associated cerebral venous thrombosis (CVT)