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oa Central African Journal of Medicine - The nephrotic syndrome and myocardial infarction - a case report

Volume 33, Issue 2
  • ISSN : 0008-9176

 

Abstract

Earlier reports that the nephrotic syndrome carries a high risk of myocardial infarction have recently been criticized. As myocardial infarction is exceedingly rare in rural African women, its occurrence in a patient with no risk factors for ischaemic heart disease other than the nephrotic syndrome, suggests a link between the two conditions. Such a case is reported and the possible underlying pathophysiological mechanisms discussed. In 1969 Berlyne and Mallick reported an 85 times greater incidence of ischaemic heart disease (IHD) in patients with the nephrotic syndrome (NS) than in the general population. This association was supported by the clinical reports by Alexander et al and Bianchi Porro and Bianchessi and the autopsy findings of Curry and Roberts. More recently, however, Wass and Cameron have criticized the clinical studies for being based on small selected series of patients, and the post-mortem study for failing to discriminate between the effects of the underlying diseases, systemic lupus erythematosus and diabetes mellitus, and the effects of the NS. Wass and coworkers, in a study of 159 unselected NS patients, found no excess cardiovascular mortality or morbidity. IHD is rare in Black Africans and is more common in urban males who have adopted a Western life-style and diet. No cases of myocardial infarction (MI) were found in two Zimbabwean studies of cardiovascular diseasel performed in the 1960s, although definite cases have occurred in recent years (unpublished data). The occurrence of an MI in a rural Black African female with NS and no other risk factor for cardiovascular disease, therefore, provides circumstantial evidence for an aetiological link.

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/content/CAJM/33/2/AJA00089176_876
1987-02-01
2019-12-15

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