Pulmonary Embolism in pediatric nephrotic syndrome

Introduction and aim:Pulmonary Embolism(PE) is a known complication of Nephrotic syndrome(NS) specially in relapse period.Frequently PE is asyptomatic and the diagnoseis not simple and needs to be suspicious to. Incidence of PE in children with NS is recognized less than adult patients and under recognized with a high rate of mortality and pulmonary hypertension.Chest CT Scan and MRA are the best diagnostic exam but lung ventilation perfusion Scan is the most available diagnostic test. Due to the H. Dirk Sotsman and colleagues, chest X Ray can be used instead of ventilation scan.In this study we are going tofind asymptomatic pulmonary embolism in pediatric nephrotic syndrome.Method: For Six children 2.5-8.5 years of age suffering of NS and hospitalized because ofNSrelapse, perfusion scan and CXR were done. They did not show any sign or symptom for PE. Perfusion scan was read in comparison to CXR and the result reported as high,moderate and low probability for pulmonary embolism.Results: 5 patients had normal CXR and perfusion scan, and one patient had a positive perfusion scan and a normal CXR. The perfusion scan demonstrated no perfusion in the left upper lobe. She was a 4.5 years old girl with serum albumin about 2mg/dl and serum triglyceride about 185 mg/dl. Treatment with Heparin was started .The Control Perfusion Scan after one month was normal.Conclusion: PE as a complication of NS is underestimated and there are some subtle cases that cannot diagnose them without performing special diagnostic tests . For prevention of the PE mortality and morbidity in pediatric NS, it needs to be vigilance.

Keywords:

nephrotic syndrome , Pulmonary embolism , perfusion scan