A 55-year-old man with biopsy-proven membranous nephropathy presents with sudden flank pain and a fall in urine output. Contrast CT shows a filling defect in the left renal vein. Among patients with nephrotic syndrome, this complication occurs most frequently with which underlying lesion?

• A Membranous nephropathy ✓
• B Minimal change disease
• C IgA nephropathy
• D Post-streptococcal glomerulonephritis

Explanation

Membranous nephropathy carries the highest risk of renal vein thrombosis among the nephrotic syndromes, attributed to loss of antithrombin III and other anticoagulant proteins in urine combined with the hypercoagulable state of heavy proteinuria. Minimal change disease also causes nephrotic syndrome but has a much lower thrombosis rate. IgA nephropathy and post-streptococcal glomerulonephritis are typically nephritic rather than heavily nephrotic, so they are not leading causes of this complication.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.