Clinical research study
Venous Thromboembolism in Patients Hospitalized with Nephrotic Syndrome

https://doi.org/10.1016/j.amjmed.2007.08.042Get rights and content

Abstract

Purpose

Whether pulmonary embolism in patients with the nephrotic syndrome is caused by deep venous thrombosis or renal vein thrombosis is controversial. To determine which is the likely cause of pulmonary embolism in patients with the nephrotic syndrome, we investigated data from the National Hospital Discharge Survey.

Methods

The number of patients discharged from nonfederal short-stay hospitals in the United States with a diagnostic code of nephrotic syndrome, deep venous thrombosis, renal vein thrombosis, and pulmonary embolism was obtained using ICD-9-M (International Classification of Diseases, Ninth Revision, Clinical Modification) codes.

Results

From 1979 to 2005, 925,000 patients were discharged from hospitals with the nephrotic syndrome and 898,253,000 patients did not have the nephrotic syndrome. With the nephrotic syndrome, 5000 (0.5%) had pulmonary embolism, 14,000 (1.5%) had deep venous thrombosis, and fewer than 5000 had renal vein thrombosis. The relative risk of pulmonary embolism comparing patients with the nephrotic syndrome to those who did not have it was 1.39, and the relative risk of deep venous thrombosis was 1.72. Among patients aged 18-39 years, the relative risk of deep venous thrombosis was 6.81. From 1991-2005, after venous ultrasound was generally available, the relative risk of deep venous thrombosis (all ages) was 1.77.

Conclusion

The nephrotic syndrome is a risk factor for venous thromboembolism. This is strikingly apparent in young adults. Renal vein thrombosis was uncommon. Therefore, pulmonary embolism, if it occurs, is likely to be due to deep venous thrombosis and not renal vein thrombosis.

Section snippets

Data Sources

The number of patients, excluding newborns and infants <1 month of age, discharged from hospitals with a diagnostic code of nephrotic syndrome from 1979 through 2005 was obtained from the National Hospital Discharge Survey.24 Among these patients, the number with pulmonary embolism, deep venous thrombosis, or renal vein thrombosis was determined.

The national hospital discharge survey consists of data obtained annually from 181,000 to 371,000 sampled patient abstracts from 400 to 494 nonfederal

Results

From 1979 through 2005, 925,000 patients were discharged from nonfederal short-stay hospitals with the nephrotic syndrome and 898,253,000 patients did not have the nephrotic syndrome. Demographic information is shown in Table 1. A higher proportion of males, a lower proportion of Whites, and a higher proportion of Blacks had the nephrotic syndrome than those who did not. Ages were the same in both groups.

Among patients with the nephrotic syndrome, 0.5% had pulmonary embolism, 1.5% had deep

Discussion

The relative risks of pulmonary embolism and deep venous thrombosis were higher in patients with the nephrotic syndrome than in those who did not have the nephrotic syndrome, indicating that the nephrotic syndrome is a risk factor for venous thromboembolic disease, as had been suggested (Table 3).1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 The relative risk of deep venous thrombosis in patients with the nephrotic syndrome was particularly high (6.81) in patients aged

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