A 6-year-old boy with nephrotic syndrome in relapse suddenly develops left flank pain, gross hematuria, and a fall in platelet count from 250,000 to 90,000/mm3. Ultrasound shows an enlarged left kidney. What is the most likely complication?

• A Acute tubular necrosis
• B Spontaneous bacterial peritonitis
• C Hypovolemic shock from intravascular volume depletion
• D Renal vein thrombosis ✓

Explanation

Nephrotic syndrome causes urinary loss of antithrombin III along with raised fibrinogen and hemoconcentration, producing a hypercoagulable state. Renal vein thrombosis classically presents with sudden flank pain, hematuria, an enlarged kidney, and falling platelets due to consumption. Spontaneous bacterial peritonitis causes fever and abdominal pain without hematuria, and hypovolemia does not explain localized flank pain with thrombocytopenia.

Reference: Nelson Textbook of Pediatrics, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.