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Nephrotic DKD Anticoagulation — ESENeph MCQ

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HardDiabetic Kidney DiseaseNephrotic DKD AnticoagulationESENeph

A patient with primary membranous nephropathy has albumin 19 g/L by bromocresol green, proteinuria 11 g/day, BMI 37 kg/m² and low estimated bleeding risk. There is no established thrombosis. What is the best anticoagulation decision?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Offer prophylactic anticoagulation after balancing thrombotic and bleeding risks

Explanation lettering: D = shown as B · B = shown as C · E = shown as D · C = shown as E

E is correct. KDIGO advises prophylactic anticoagulation when thromboembolic risk exceeds patient-specific serious-bleeding risk. Membranous nephropathy, albumin below 20–25 g/L, proteinuria above 10 g/day and BMI above 35 all increase this patient’s venous risk, making prophylaxis reasonable after shared assessment. It is not universal for nephrotic syndrome, and eGFR alone is insufficient. Aspirin is not an equivalent strategy for venous-risk prevention. Albumin assay method matters because thresholds differ with bromocresol purple or immunoassay, and the regimen must account for kidney function, drug interactions and adherence.

Reference: KDIGO 2021 glomerular-disease guideline: https://kdigo.org/wp-content/uploads/2021/10/KDIGO-2021-Guideline-for-the-Management-of-Glomerular-Diseases.pdf