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Mesenteric Arterial Thrombosis Nephrotic — ESENeph MCQ

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HardGlomerulonephritisMesenteric Arterial Thrombosis NephroticESENeph

A 50-year-old man with membranous nephropathy develops sudden onset severe abdominal pain. CT angiography shows occlusion of the superior mesenteric artery. His albumin is 14 g/L. What has occurred?

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Correct answer: E — Acute mesenteric ischaemia from arterial thromboembolism – nephrotic syndrome hypercoagulability can cause arterial as well as venous thrombosis

Acute mesenteric arterial occlusion is a rare but life-threatening thrombotic complication of nephrotic syndrome. The hypercoagulable state in nephrotic syndrome affects both venous and arterial systems. Mesenteric ischaemia requires emergency vascular surgery (embolectomy, resection of non-viable bowel). Mortality is high (50-80%) if not diagnosed and treated within 6-12 hours. This reinforces the importance of thromboprophylaxis in severe nephrotic syndrome (albumin <20-25 g/L) and maintaining a high index of suspicion for thrombotic complications in any vascular territory.

Reference: KDIGO 2021 – GN (Thrombosis); Singhal and Brimble 2006 – Nephrotic Arterial Thrombosis