Nephrotic Syndrome - Complications

Complications

• Venous thrombosis: due to leak of anti-thrombin 3, which helps prevent thrombosis. This often occurs in the renal veins. Treatment is with oral anticoagulants (not heparin as heparin acts via anti-thrombin 3 which is lost in the proteinuria so it will be ineffective.) Hypercoagulopathy due to extravasation of fluid from the blood vessels (oedema) is also a risk for venous thrombosis.

• Infection: due to leakage of immunoglobulins, encapsulated bacteria such as Haemophilus influenzae and Streptococcus pneumoniae can cause infection.

• Acute renal failure is due to hypovolemia. Despite the excess of fluid in the tissues, there is less fluid in the vasculature. Decreased blood flow to the kidneys causes them to shutdown. Thus it is a tricky task to get rid of excess fluid in the body while maintaining circulatory euvolemia.

• Pulmonary edema: again due to fluid leak, sometimes it leaks into lungs causing hypoxia and dyspnoea.

• Growth retardation: does not occur in MCNS.It occurs in cases of relapses or resistance to therapy. Causes of growth retardation are protein deficiency from the loss of protein in urine, anorexia (reduced protein intake), and steroid therapy (catabolism).

• Vitamin D deficiency can occur. Vitamin D binding protein is lost.

• Hypothyroidism can occur. Thyroxine is reduced due to decreased thyroid binding globulin.

• Microcytic hypochromic anaemia is typical. It is iron-therapy resistant.

• Hypocalcemia can occur as a result of nephrotic syndrome. It may be significant enough to cause tetany. Hypocalcemia may be relative; calcium levels should be adjusted based on the albumin level and ionized calcium should be checked.

• Cushing's Syndrome