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Nephrotic syndrome is associated with thromboembolic disease due to a variety of factors. In addition, therapy with anticoagulants is often met with poor response, to warfarin for example, which occurs due to factors such as reduced serum albumin and binding sites, increased free warfarin with rapid metabolism and clearance, and possible urinary loss. Bezafibrate is known to augment the action of warfarin and improve coagulation profile. In this article, we present three cases with severe nephrotic syndrome associated with hyperfibrinogenemia, hypercholesterolemia and thromboembolic disease who showed poor response to therapy with warfarin. They showed improvement of their coagulation profile upon concomitant administration of bezafibrate.

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Features suggestive of thrombotic thrombocytopenic purpura (TTP) are known to occur in patients with systemic lupus erythematosus (SLE). We report a patient who had TTP which resolved with plasma exchange and immunosuppression, but presented three years later with features of SLE. The diagnosis satisfied all the required criteria in both instances. The interrelationship between the two conditions is discussed.

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Acute renal failure (ARF) following rhabdomyolysis is a well known entity. In this paper, we present an unusual cause for trauma that resulted in rhabdomyolysis associated with renal failure. Rhabdomyolysis resulted from human stampede that occurred in a mountain tunnel on the occasion of The Pilgrimage to Makkah in 1990. To the best of our knowledge, human stampede as a cause of rhabdomyolysis has not been reported in the literature. A total of eight patients were referred to our center. Laboratory investigations revealed rhabdomyolysis as well as evidence of moderate to severe renal impairment in all patients. They were treated with forced alkaline diuresis, but three required hemodialysis. All patients recovered. Treatment with forced alkaline diuresis was found to be useful in the treatment of these patients and instituting such treatment is worthwhile even in those cases where renal failure is established.

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In addition to the standard biochemical measures we need better methods for monitoring of glomerulonephritides. A variety of new tests are now available. One has to be selective in one's choice. Attention has to be paid to means of assessing interstitial fibrosis and damage to the tubules of the kidneys.

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We describe our experience with spontaneous arterial thrombosis (AT) in two men with nephrotic syndrome secondary to minimal change glomerulonephritis. Arterial thrombosis developed shortly after a nephrotic crisis in each case. Serum antithrombin III, protein C and protein S levels were normal in both patients. The two cases emphasize the role of defective hemodynamic circulation in the pathogenesis of AT in patients with nephrotic syndrome. Despite their atastrophic presentation, the patients ultimately responded to multiple thrombectomies, volume expanders, anticoagulants and steroid therapy.

[ABSTRACT]  [FULL TEXT]  [PDF]  [PubMed]

[FULL TEXT]  [PDF]  [PubMed]