Thromboembolic complication

Several well-recognized glomerulopathies in children may result in nephrotic range proteinuria. A possible complication of nephrotic syndrome and its treatment is thromboembolic complications (TEC). Patients with membranous glomerulopathy with heavy proteinuria and lupus nephritis/antiphospholipid syndrome run the highest risk of thromboembolic complications. A lower incidence of TEC has been found in children with nephrotic syndrome as compared with adults with NS, although children had severe morbidity. Clinically silent thromboembolic complications may be much more common than previously reported in studies designed to collect data only from symptomatic events. Thus, this chapter covers the pathogenesis of thromboembolic complications in children with heavy proteinurias, either with acquired thrombophilia or associated with congenital hemostasis disorders. Moreover, the clinical features of patients experiencing venous and arterial thromboemolic complications in different areas of the body, such as the lungs, kidneys, brain and heart, will be described. The prevention of thromboembolism in patients at high risk, either through drugs or through appropriate management of the main condition, will be emphasized. In addition, treatment options after a thromboembolism has begun will be discussed. Patients with lupus nephritis/antiphospholipid syndrome run the highest risk of thromboembolic complications. Venous thrombosis is more frequent than arterial thrombosis. Systemic lupus eritematosus patients with nephritis are more prone to arterial thromboembolic complications than those without renal involvement. The chapter also covers the pathogenesis of TEC in lupus nephritis patients, with particular emphasis on antiphospholipid antibodies. However, we present the clinical features of patients with either thrombotic microangiopathy or vasal thrombosis and their treatment options. Finally, a concise overview of physiological hemostasis is given