A 58-year-old man presents with sudden left flank pain, gross haematuria, and worsening oedema two months after being diagnosed with nephrotic syndrome (proteinuria 9 g/day). CT abdomen shows a filling defect in the left renal vein extending into the inferior vena cava. Which underlying glomerular disease is most strongly associated with this complication?

• A Membranous nephropathy ✓
• B Minimal change disease
• C IgA nephropathy
• D Diabetic nodular glomerulosclerosis

Explanation

Renal vein thrombosis is the classic thrombotic complication of nephrotic syndrome and is most frequently associated with membranous nephropathy in adults, occurring in up to a third of cases. Urinary losses of antithrombin III along with increased fibrinogen and platelet hyperactivity create the prothrombotic state. The distractor minimal change disease is the commonest paediatric cause of nephrotic syndrome but carries a much lower risk of venous thrombosis than membranous nephropathy.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.