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Nephrotic Syndrome Arterial Thrombosis — ESENeph MCQ

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ModerateGlomerulonephritisNephrotic Syndrome Arterial ThrombosisESENeph

A 42-year-old man with nephrotic syndrome from MCD develops acute abdominal pain. CT abdomen shows splenic infarction. What is the pathophysiology?

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Correct answer: A — Hypercoagulability of nephrotic syndrome causing arterial thromboembolism – loss of anticoagulant proteins (antithrombin III, protein C, protein S) with increased procoagulant factors (fibrinogen, factor V, VIII)

Nephrotic syndrome creates a prothrombotic state through multiple mechanisms: urinary loss of antithrombin III, protein C, and protein S (anticoagulant proteins); hepatic overproduction of procoagulant factors (fibrinogen, factors V, VIII, XIII); increased platelet aggregation; hyperviscosity from haemoconcentration; and hyperlipidaemia. While renal vein thrombosis and DVT/PE are the most common sites, arterial thromboembolism (splenic, mesenteric, cerebral, coronary) can also occur. The risk correlates with severity of hypoalbuminaemia.

Reference: KDIGO 2021 – GN Guideline (Thrombosis); Kerlin et al 2012 – Nephrotic Thrombosis