Fulminant cerebral infarctions with membranous nephropathy

Area of Science:

• Nephrology
• Neurology
• Hematology

Background:

• Arterial thromboses, including cerebral infarction, are rare complications associated with nephrotic syndrome.
• Nephrotic syndrome is a kidney disorder that causes the body to excrete too much protein in its urine.

Observation:

• A 37-year-old woman experienced right upper extremity ischemia, left middle cerebral artery thrombosis, and right cerebellar infarction.
• The patient rapidly herniated, and postmortem examination revealed membranous nephropathy.
• Laboratory results showed elevated fibrinogen and decreased free protein S levels.

Findings:

• Membranous nephropathy, a cause of nephrotic syndrome, can precipitate rapidly progressive cerebral infarctions.
• The observed thrombotic events in this case were severe, leading to fatality.
• The specific hematologic mechanisms underlying strokes in nephrotic syndrome remain unclear.

Implications:

• This case underscores the critical need for heightened awareness of thrombotic risks in patients with nephrotic syndrome, particularly those with membranous nephropathy.
• Early recognition and management of hypercoagulable states in nephrotic syndrome may be crucial for preventing severe neurological complications.
• Further research is warranted to elucidate the precise hemostatic abnormalities contributing to arterial thrombosis in nephrotic syndrome.