Abstract
Nephrotic syndrome (NS) is characterized by heavy proteinuria, edema, hypoalbuminemia,
and hyperlipidemia and the most frequent causes are glomerular diseases. An uncommon
presentation is iatrogenic NS, an adverse effect of some drugs administration. In
the clinical course of NS, a typical feature is dysregulated coagulation state, promoted
by the breakdown of permselectivity barrier of the glomerular capillary wall, resulting
in the leakage of high-molecular-mass proteins, at least the size of albumin. This
hypercoagulable condition is supported by several factors, such as abnormalities in
platelet activation and an imbalance between anticoagulation/antithrombosis and procoagulant/prothrombotic
mechanisms. Thus, NS and the risk of developing thromboses are strictly related. Thrombotic
events affect the venous system rather than arterial vessels with different features
and frequencies. Deep venous system of the lower extremities and renal veins are the
most frequent source of pulmonary embolism, the most dangerous NS complication. Prophylactic
anticoagulation and thrombosis treatment are not clearly established because large
randomized trials and guidelines are lacking. The management of NS and the decision
of when and how to anticoagulate the patient represent a teamwork challenge for physicians.
Keywords
arterial thrombosis - deep vein thrombosis - nephrotic syndrome - proteinuria - renal
vein thrombosis - pulmonary embolism
