Nephrotic Syndrome Complicated by Life-Threatening Pulmonary Embolism in an Adult Patient

本文報告一例23歲男性，因為下肢水腫而住院實施腎臟切片。住院後因為急性腹痛而實施剖腹手術。而後因為寡尿及氮血症而短暫的施行血液透析。不幸的突然發生嚴重的呼吸衰竭，動脈氣體分析顯示低血氧及明顯的動脈－肺泡氧氣飽和度差，懷疑是發生肺動脈栓塞，但因為插了氣管內管而無法實施核子醫學造影。為治療肺動脈栓塞及本身腎病症候群，給予皮下低分子量肝素及靜脈注射類固醇。在經過肝素及類固醇治療後，病人血中氧濃度逐漸上升，成功拔管。核磁共振血管攝影顯示一條主肺動脈完全阻塞及其他小動脈部份阻塞。病人出院後於門診規則服用口服可邁丁錠(warfarin)及類固醇。五個月後追蹤其核磁共振血管攝影：呈現正常肺動脈血管攝影，無阻塞情形。

關鍵字

低分子量肝素；腎病症候群；肺動脈栓塞

並列摘要

We report a 23-year-old male presenting with edema. He was originally admitted for an elective renal biopsy for diagnosis of renal pathology. Unfortunately, because of acute abdominal pain an exploratory laparotomy was done. Progressive azotemia and oliguria then developed, and he required temporary hemodialysis. However, he suffered from sudden-onset severe respiratory distress, and blood gas analysis showed profound hypoxemia with a marked arterial-alveolar oxygen difference. Assessment of a pulmonary embolism by radioisotope imaging was not possible because of his dependence on mechanical ventilation. Subcutaneous low molecular weight heparin and intravenous methylprednisolone were given to treat the presumed pulmonary embolism and the underlying nephrotic syndrome. His partial oxygen level gradually increased after continuous heparin and steroid administration. Complete obliteration of one major pulmonary artery and partial obliteration of other smaller arteries were revealed by magnetic resonance angiography. He was discharged and followed-up as an outpatient, and was given oral warfarin and prednisolone. Follow-up magnetic resonance angiography 5 months later showed a normal pulmonary tree with no residual lesions.

並列關鍵字

low molecular weight heparin ； nephrotic syndrome ； pulmonary arterial thromboembolism

國際替代計量

Nephrotic Syndrome Complicated by Life-Threatening Pulmonary Embolism in an Adult Patient

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