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MN PE Malignancy Screening — ESENeph MCQ

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HardGlomerulonephritisMN PE Malignancy ScreeningESENeph

A patient with primary membranous nephropathy has albumin 19 g/L but no previous thrombosis. Estimated thrombotic risk is high and a validated assessment suggests substantial gastrointestinal bleeding risk. What is the best prophylaxis decision?

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

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Correct answer: B — Individualised anticoagulation using predicted thrombosis and bleeding risk

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

D is correct. Membranous nephropathy carries a particularly high venous-thromboembolism risk as albumin falls, but primary prophylaxis is not triggered by albumin in isolation. KDIGO uses an individual estimate of thrombotic risk alongside anticoagulant-specific bleeding risk and patient preference. A ignores a major competing hazard and uses treatment-dose language for prophylaxis. B reverses the venous risk. C substitutes an antiplatelet drug for reliable VTE prophylaxis. E abandons prevention in a high-risk patient. Established thrombosis is different and requires therapeutic anticoagulation unless contraindicated; this stem specifically concerns primary prophylaxis.

Reference: KDIGO 2021 guideline for glomerular diseases: https://kdigo.org/wp-content/uploads/2024/05/KDIGO-2021-Glomerular-Diseases-Guideline_English_2024-Chapter-Updates.pdf