What is your approach to systemic anticoagulation for patients with hypoalbuminemia and nephrotic syndrome secondary to a non-membranous nephropathy condition?
Patients with nephrotic syndrome (NS) and hypoalbuminemia have a several-fold higher risk of venous thromboembolism (VTE) than the general population and also a somewhat higher risk of arterial thromboembolism (ATE), such as MI and stroke. This risk seems to be higher in membranous nephropathy (MN) ...
Generally, I prefer AC for patients with serially declining albumin (usually <2.5 g/dL) and proteinuria >10 g/g, as well as other risk factors for thrombosis (NYHA 3/4, immobilization, factor 5 Leiden, AF, history of VTE, etc.). The question is how quickly I can get the patient in remission, and how...
All nephrotic proteinuria is associated with increased risk of thrombosis, but membranous nephropathy in particular has the highest associated risk (see Barbour et al., PMID 21918501). In adults with non-membranous nephrotic syndrome, I reserve anticoagulation for patients with a history of venous t...