A 35-year-old patient with nephrotic syndrome (proteinuria 6.8 g/day, serum albumin 1.8 g/dL) develops a flank pain and haematuria. Doppler ultrasound shows no flow in the left renal vein. Which anticoagulation is recommended?
- A Thrombolysis with alteplase
- B Surgical thrombectomy
- C Anticoagulation with low molecular weight heparin bridging to warfarin for at least 3-6 months ✓
- D Observation — anticoagulation not recommended due to bleeding risk from low albumin
Correct answer: C. Anticoagulation with low molecular weight heparin bridging to warfarin for at least 3-6 months
Explanation
Renal vein thrombosis is a recognised thromboembolic complication of nephrotic syndrome (especially membranous nephropathy), driven by urinary loss of anticoagulant proteins (antithrombin III, protein C/S) and elevated fibrinogen. Treatment is anticoagulation with LMWH bridging to warfarin (or DOAC in appropriate cases) for at least 3-6 months while nephrotic syndrome is active. Thrombolysis is reserved for acute bilateral RVT with AKI. Surgery is rarely indicated. Anticoagulation is clearly indicated to prevent further thrombosis.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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