Nephrology: renal vein thrombosis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Nephrology: renal vein thrombosis

Sample item

A 40-year-old man with biopsy-proven membranous nephropathy (urinary protein 8 g/day, serum albumin 1.8 g/dL) develops sudden left flank pain, gross haematuria and a rise in serum creatinine. Which complication is most likely?

ARenal vein thrombosisBAcute pyelonephritisCRenal papillary necrosisDObstructing ureteric calculus

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Renal vein thrombosis

Nephrotic syndrome is prothrombotic because urinary loss of antithrombin and other anticoagulant proteins, together with hepatic overproduction of clotting factors and hypoalbuminaemia, tips the balance towards coagulation. Membranous nephropathy carries the highest risk of renal vein thrombosis, which presents with flank pain, haematuria and a rising creatinine. Diagnosis is by CT or MR venography, and treatment is anticoagulation.

Option by option

A. Renal vein thrombosis (correct)
Correct. Urinary antithrombin loss with severe membranous disease predisposes to renal vein thrombosis.
B. Acute pyelonephritis
Pyelonephritis presents with fever, pyuria and loin tenderness, and nephrotic syndrome does not specifically predispose to it.
C. Renal papillary necrosis
Papillary necrosis follows analgesic abuse, diabetes or sickle cell disease and is not a nephrotic complication.
D. Obstructing ureteric calculus
A calculus is possible but does not fit the nephrotic state and creatinine rise in the context of known membranous disease.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Renal vein thrombosis. Nephrotic syndrome is prothrombotic because urinary loss of antithrombin and other anticoagulant proteins, together with hepatic overproduction of clotting factors and hypoalbuminaemia, tips the balance towards coagulation.

Why is "Acute pyelonephritis" not the answer?

Pyelonephritis presents with fever, pyuria and loin tenderness, and nephrotic syndrome does not specifically predispose to it.

Why is "Renal papillary necrosis" not the answer?

Papillary necrosis follows analgesic abuse, diabetes or sickle cell disease and is not a nephrotic complication.

Why is "Obstructing ureteric calculus" not the answer?

A calculus is possible but does not fit the nephrotic state and creatinine rise in the context of known membranous disease.

What concept does this question test?

It tests Nephrology: renal vein thrombosis in General Medicine. Membranous nephropathy carries the highest risk of renal vein thrombosis, which presents with flank pain, haematuria and a rising creatinine. Diagnosis is by CT or MR venography, and treatment is anticoagulation.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Nephrology: renal vein thrombosis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.