Membranous nephropathy with inferior vena cava and renal vein thrombosis 

Abstract

A biopsy proven membranous nephropathy female came to the hospital with fever and bilateral lumbar pain. There were no urinary or respiratory symptoms. The workup revealed a creatinine of 1.4 mg/dL, low serum albumin and 3+proteins in the urine. Her erythrocyte sedimentation rate (ESR) was raised and her serology showing a C3 and C4 of complements of 2.24 and 0.41 respectively. Notably,  antinuclear antibody (ANA) was strongly positive, anti-dsDNA was negative. Ultrasonography showed slight echogenic kidneys with a hematoma seen in her left kidney. Then a CT scan of chest, abdomen and pelvis was planned that revealed enlarged and swollen kidneys having indistinct cortico-medullary junction and a partial thrombus in the inferior vena cava (IVC) and the renal veins. Antiphospholipid antibodies serology and D-dimer levels were unremarkable. She was given streptokinase infusion that resulted in recovery of her renal functions and later on kept on lifelong warfarin. 

Keywords: Nephrotic syndrome, Membranous glomerulonephritis, Renal vein thrombosis, Streptokinase