Wednesday, September 30, 2020

Nephrotic syndrome and ACS

 Q: Nephrotic syndrome may cause acute compartment syndrome (ACS) of the extremities? (select one)

A) True

B) False

Answer: A

Nephrotic syndrome decreases the serum osmolarity and may result in ACS. There is a long list of non-traumatic causes of ACS. These conditions are hard to differentiate due to concomitant other primary underlying medical pathologies, like ischemia-reperfusion injury, bleeding disorders, chemical DVT prophylaxes, vascular diseases, envenomations, injection of recreational drugs, aggressive IV fluid resuscitation in ICU, poor positioning during surgery or in bed, Group A streptococcus infections of muscle, and post saphenous vein harvesting during heart bypass surgery. These conditions require astute diagnosis and frequently surgical interventions. Please see the reference section for some interesting case reports.



1. Elliott KG, Johnstone AJ. Diagnosing acute compartment syndrome. J Bone Joint Surg Br 2003; 85:625. . 

2. Kleshinski J, Bittar S, Wahlquist M, et al. Review of compartment syndrome due to group A streptococcal infection. Am J Med Sci 2008; 336:265. 

3. Patel YA, Marzella N. Dietary Supplement-Drug Interaction-Induced Serotonin Syndrome Progressing to Acute Compartment Syndrome. Am J Case Rep 2017; 18:926. 

4. Burnside J, Costello JM Jr, Angelastro NJ, Blankenship J. Forearm compartment syndrome following thrombolytic therapy for acute myocardial infarction. Clin Cardiol 1994; 17:345. 

5. Yip TR, Demaerschalk BM. Forearm compartment syndrome following intravenous thrombolytic therapy for acute ischemic stroke. Neurocrit Care 2005; 2:47. 

6. Roberge RJ, McLane M. Compartment syndrome after simple venipuncture in an anticoagulated patient. J Emerg Med 1999; 17:647. 

7. Mills J, Pretorius V, Lording T, et al. Bilateral anterior compartment syndrome after routine coronary artery bypass surgery and severe hypothyroidism. Ann Thorac Surg 2010; 90:1338. 

8. Kolli A, Au JT, Lee DC, et al. Compartment syndrome after endoscopic harvest of the great saphenous vein during coronary artery bypass grafting. Ann Thorac Surg 2010; 89:271. 

9. O'Connor G, McMahon G. Complications of heroin abuse. Eur J Emerg Med 2008; 15:104. Köstler W, Strohm PC, Südkamp NP. Acute compartment syndrome of the limb. Injury 2004; 35:1221. 

10. Defraigne JO, Pincemail J. Local and systemic consequences of severe ischemia and reperfusion of the skeletal muscle. Physiopathology and prevention. Acta Chir Belg 1998; 98:176.

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