DOI: 10.12890/2026_006359
Unprovoked pulmonary embolism with bilateral deep vein thrombosis revealing occult nephrotic syndrome due to seronegative membranous nephropathy
Authors
felix@brombachers.de
Keywords
Pulmonary embolism, membranous nephropathy, nephrotic syndrome, venous thrombembolism, proteinuriaAbstract
Introduction: Nephrotic syndrome is a well-recognised risk factor for venous thromboembolism (VTE) but may present without oedema, hyperlipidaemia or impaired kidney function, delaying diagnosis.
Case description: A 73-year-old man presented with fatigue, exertional dyspnoea and weight loss over a period of three months. Computed tomography pulmonary angiography showed bilateral central pulmonary emboli. Cardiac biomarkers were elevated with preserved renal function. Therapeutic anticoagulation was initiated. To assess thrombus extent and guide management, lower limb compression ultrasonography was performed and revealed bilateral popliteal deep vein thrombosis. Urinalysis demonstrated nephrotic-range proteinuria (8 g/day) with hypoalbuminaemia and microscopic haematuria. Evaluation for other secondary causes of thrombembolism was unremarkable. Anti-phospholipase A2 receptor and thrombospondin type-1 domain-containing 7A antibodies were negative. Corticosteroid treatment was commenced. A transjugular kidney biopsy confirmed membranous nephropathy, and rituximab was administered for long-term immunosuppressive management.
Discussion: This case illustrates that nephrotic syndrome can be clinically occult and should be considered in unprovoked or extensive VTE, particularly when bilateral deep vein thrombosis is present.
Conclusion: Urine dipstick testing, and serum albumin should be considered early in the work-up of unexplained VTE, even in the absence of oedema or reduced estimated glomerular filtration rate.
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