A young man, aged 26, was recently transferred from the Department of Respiratory Medicine to the Department of Cardiology with chest pain, diagnosed as pulmonary embolism, and was transferred to the Department of Respiratory Medicine, where he was given thrombolysis and other treatments.
Pulmonary embolism is a clinical pathophysiological syndrome (PE) in which various emboli from the body circulation are dislodged and obstruct the pulmonary artery and its branches, causing pulmonary circulation obstruction. The most common pulmonary embolus is thrombus, and pulmonary embolism caused by thrombus is also called pulmonary thromboembolism. Patients suddenly experience unexplained deficiency, pallor, cold sweat, dyspnea, chest pain, cough, and other symptoms of cerebral hypoxia such as extreme anxiety, lethargy, nausea, convulsions, and coma. Acute pulmonary embolism has the third highest mortality rate, after tumor and myocardial infarction. The young patient had a large pulmonary embolism, but finally managed to survive from the dead, considering that it was related to the repeated chest tightness and discomfort in the 2 months before the onset of the disease, the local doctor simply treated the patient for pneumonia, and although the condition improved, the diagnosis was not clear.
Nephrotic syndrome (nephropathy for short) is a clinical syndrome caused by increased permeability of the glomerular basement membrane, resulting in the loss of large amounts of plasma protein from the urine. The main features are three highs and one low, i.e., massive proteinuria (≥3.5 g/d), edema, hyperlipidemia, and low plasma protein (≤30 g/L). In severe cases, there will be plasma cavity effusion and anuric manifestations. Not all patients in the clinic have the typical manifestations of three highs and one low. Many patients do not have edema, called dry edema, which is often insidious and difficult to detect, as in this patient, with massive proteinuria and severe hypoproteinemia without significant edema.
Patients with nephrotic syndrome are prone to thrombosis, especially membranous nephropathy with an incidence of 25% to 40%. The causes of thrombosis include edema, low patient activity, venous stasis, hyperlipidemia, increased viscosity due to blood concentration, high fibrinogen content and increased v, VII, VIII, and x factors, and the use of adrenocorticotropic hormones that predispose the blood to hypercoagulability.
Clinical diseases are very variable, and when you meet a good doctor, you can often be diagnosed and treated in a timely manner. It is more important to be careful and pay attention to every symptom, especially the recurring ones, to prevent missing the best time! This patient had foamy urine early on but did not pay attention to it, which eventually led to serious complications!