A 58-year-old man with nephrotic syndrome (proteinuria 9 g/day) suddenly develops left flank pain, gross hematuria, and worsening renal function. Contrast CT shows a filling defect in the left renal vein. Which glomerular disease carries the strongest association with this complication?
- A Minimal change disease
- B IgA nephropathy
- C Primary membranous nephropathy ✓
- D Post-infectious glomerulonephritis
Correct answer: C. Primary membranous nephropathy
Explanation
Membranous nephropathy is the nephrotic disorder most strongly linked to renal vein thrombosis and other thromboembolic events. Urinary loss of antithrombin III, along with increased fibrinogen and platelet hyperaggregability, creates the hypercoagulable state. Minimal change disease also loses antithrombin III, but its thrombotic risk is distinctly lower than that of membranous nephropathy, which is the classic examination answer.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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