Madhav Venkatesan
1* 
, Anil Mathew
1, Rajesh Nair
1, George Kurian
1, Seethalekshmy NV
2, Sandeep Sreedharan
1*, Zachariah Paul
11 Department of Nephrology, Amrita Institute of Medical Sciences, Kochi, India
2 Department of Pathology, Amrita Institute of Medical Sciences, Kochi, India
Abstract
Background: Venous and arterial thromboembolism are frequently seen in nephrotic
syndrome. They generally occur during periods of sustained proteinuria in patients who
are not responding to treatment and more commonly seen in minimal change disease and
membranous nephropathy.
Case Presentation: A 28-year-old male presented to cardiology department of our hospital
with worsening breathlessness for 1 week. We found pulmonary embolism and an infarct
in the lower pole of the right kidney by CT pulmonary angiogram.
He had no previous history or features of nephrotic syndrome. Urine analysis showed
numerous red blood cells, 3+ proteinuria and granular casts. Urine protein creatinine ratio
was 5.2 g/g of creatinine. Serum creatinine was 2.61 mg/dL. Renal biopsy was suggestive
of IgA nephropathy and patient was started on steroids and warfarin and responded to
treatment.
Conclusions: Patients with nephrotic syndrome can rarely present initially with venous
and arterial thromboembolism. Rarely even IgA nephropathy can present with such
thromboembolic episodes.
Implication for health policy/practice/research/medical education:
Arterial and venous thrombosis commonly occurs after a prolonged period of nephrotic syndrome and hypoalbuminemia. In
some rare cases, the initial presentation can itself just be arterial/venous thrombosis. Hence we should search for nephrotic
syndrome in patients with thrombotic episodes. Though it is more commonly seen in minimal change disease, it can also be
seen in IgA nephropathy.
Please cite this paper as: Venkatesan M, Mathew A, Nair R, Kurian G, NV S, Sreedharan S, Paul Z. IgA nephropathy presenting
with pulmonary thromboembolism and renal artery infarct. J Nephropathol. 2019;8(3):e29. DOI: 10.15171/jnp.2019.29.