Báo cáo một trường hợp huyết khối nhiều xoang tĩnh mạch não ở bệnh nhân hội chứng thận hư=Report of a case of multiple cerebral venous thrombosis in a patient with nephrotic syndrome

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Tác giả: Đức Tình Nguyễn, Xuân Tài Nguyễn

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.242-247

Bộ sưu tập: Metadata

ID: 477882

Thêm vào giỏ

Hội chứng thận hư được định nghĩa bởi những đặc điểm: protein niệu ≥ 3,5g/24h, albumin máu thấp, phù và tăng lipid máu. Có nhiều cơ chế bệnh sinh gây ra hội chứng thận hư. Đa phần sang thương thận tối thiếu thường gặp ở trẻ dưới 10 tuổi, trong khi người lớn thường do bệnh thận màng. Tình trạng tăng đông và biến chứng huyết khối có thể thấy ở hội chứng thận hư bất kể nguyên nhân gì, huyết khối hay xảy ra nhất ở tĩnh mạch sâu chi dưới và tĩnh mạch thận. Trường hợp bệnh của chúng tôi vào viện vì đau đầu, không có dấu thần kinh khu trú, sau mới xuất hiện triệu chứng phù mắt, chân và tràn dịch đa màng. Kết quả MRI não mạch não cho thấy huyết khối các xoang tĩnh mạch dọc trên, xoang ngang và xoang sigma. Bệnh nhân được điều trị lovenox sau chuyển sang xarelto kết hợp với prednisolone. Sau 14 ngày điều trị, triệu chứng thuyên giảm. Trường hợp báo cáo này nhấn mạnh huyết khối xoang tĩnh mạch là biến chứng hiếm gặp của hội chứng thận hư với các triệu chứng phù và tràn dịch đa màng xuất hiện sau khi huyết khối được chẩn đoán.Nephrotic syndrome is defined by characteristic features including proteinuria of ≥ 3,5g/24h, hypoalbuminemia, edema and hyperlipidemia. Multiple nephropathies can result in nephrotic syndrome. Most commonly, minimal change disease is seen in children under the age of 10, while adults are more commonly found to have membranous nephropathy. Hypercoagulability and thrombotic complication can be seen in nephrotic syndrome, regardless of underlying etiology, and thrombosis is most commonly seen in deep veins of the lower extremities and renal veins. Our case presented with headache but no neurologic deficits, then he developed eyes socket and peripheral edema, pleural effusion and ascites. MRI showed superior sagittal sinus, transverse sinus and sigma sinus thrombosis. He was treated with lovenox then switched to xarelto combined prednisolone. After 14 days of treatment, his symptoms were improved. This report emphasizes on cerebral venous sinus thrombosis is a rare complication of nephrotic syndrome that its symptoms developed after thrombosis was diagnosed.

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