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Thrombosis in nephrotic syndrome — ESENeph MCQ

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HardTherapeutics and Safe PrescribingThrombosis in nephrotic syndromeESENeph

A 58-year-old man with nephrotic syndrome from membranous nephropathy develops pleuritic chest pain. Albumin is 18 g/L and urine PCR is 1050 mg/mmol. CT pulmonary angiography confirms pulmonary embolism and there is no bleeding risk. What is the most appropriate management?

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Correct answer: B — Therapeutic anticoagulation with renal-function adjusted agent

Nephrotic syndrome, particularly membranous nephropathy with very low albumin, is prothrombotic and confirmed PE requires therapeutic anticoagulation adjusted for renal function. Aspirin alone is inadequate for venous thromboembolism. Diuretics may treat oedema but not PE. The pearl is that hypoalbuminaemia can affect protein-bound drugs and bleeding/thrombosis risk, so anticoagulant selection needs specialist consideration.

Reference: KDIGO 2021 Glomerular Diseases Guideline; BNF anticoagulation guidance