• Yu-Che Tsai, Yuan-Kai Hsieh, and Chien-Te Lee.
• Division of Nephrology, Department of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC.
• Med Princ Pract. 2007 Jan 1;16(4):321-3.

ObjectiveThis study describes a patient with nephrotic syndrome who experienced recurrent pulmonary emboli as renal disease relapsed frequently.Clinical PresentationA 30-year-old male, who was diagnosed as having nephrotic syndrome at 12, presented with general edema, ascites and hypoalbuminemia. Although the patient responded well to steroid therapy, a common cold frequently caused flare-up of nephrotic syndrome. Histopathological examination of renal tissue revealed minimal disease change. At 17, the patient had a first pulmonary embolism attack with concurrent upper respiratory tract infection. Full-blown manifestations of nephrotic syndrome with low antithrombin III levels were identified at that time. Anticoagulant therapy was administered to treat the pulmonary embolism. Since the first attack, several episodes of pulmonary emboli occurred, which, combined with kidney disease, triggered refractory nephrotic syndrome. The nephrotic syndrome did not remit, and a secondary renal biopsy identified glomerular pathological changes similar to previous biopsy results. To prevent recurrent pulmonary emboli, a Greenfield inferior vena cava filter was implanted in April 2002. No further pulmonary embolism events occurred after interventional filter deployment.ConclusionThe results of this study suggest that inferior vena cava filter implantation can be effective for preventing recurrent pulmonary embolism complicating refractory nephrotic syndrome.

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