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Transfemoral thrombolysis with thrombosuction: an aid to renal biopsy in a case of acute Budd Chiari syndrome complicating nephrotic syndrome
  1. Arvind Vaidyanathan1,
  2. Mayuri Trivedi1,
  3. Vivek Ukirde2 and
  4. Niteen Karnik1
  1. 1Department of Medicine, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
  2. 2Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
  1. Correspondence to Dr Mayuri Trivedi; mayuritrivedi80{at}yahoo.co.in

Abstract

Renal biopsy is usually a prerequisite in the diagnosis of adult patients with nephrotic syndrome. Acute Budd Chiari syndrome is a known complication of certain aetiologies of nephrotic syndrome like membranous glomerulopathy and minimal change disease. This complication requires emergent anticoagulation, which would preclude the performance of a renal biopsy. We report the case of a 47-year-old woman who presented with acute Budd Chiari syndrome as the initial presentation of nephrotic syndrome. The difficult situation in which we had to give anticoagulation and also perform a renal biopsy led us to devise a novel way to treat the patient, namely, the initial use of transfemoral thrombolysis and thrombosuction followed by a renal biopsy, which confirmed the diagnosis of primary membranous nephropathy. Anticoagulation was safely instituted 48 hours later with documented clinical and radiological improvement.

  • Portal vein
  • Interventional radiology
  • Nephrotic syndrome
  • Renal intervention

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Footnotes

  • Twitter @234arvind, @mayuritrivedi80

  • Contributors MT is the corresponding author and have played a key role in reviewing, analysing and interpreting the data as well as in writing the entire manuscript. AV has conceptualised the design of the study and the presentation of the manuscript as well revising its final version. VU is our interventional radiologist who has actually performed the entire intervention. NK has contributed intellectual content of vital importance and will revise it and shall approve of the final version if it shall be considered for publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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