Intracardiac thrombus and multiple venous thromboses revealing focal segmental glomerulosclerosis.
Mohammed Hamzaoui, Imane Machmachi, Khaoula Amar et al.
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Case in brief
A 51-year-old woman presented with two weeks of lower-limb edema and hematuria. Imaging showed lower-extremity deep vein thrombosis, partial left renal vein thrombosis, and a 23 × 20 mm left ventricular thrombus. Investigations found nephrotic syndrome, with a urine protein-to-creatinine ratio of 10 g/g and serum albumin of 23 g/L, alongside stage 2 acute kidney injury. ANCA and anti-PLA2R testing was negative; kidney biopsy established focal segmental glomerulosclerosis. Therapeutic anticoagulation, diuretics, and corticosteroids were followed by progressive clinical and biological improvement.
What made this case unusual
The combination of a left ventricular thrombus and multiple venous thromboses was the initial manifestation of nephrotic syndrome due to focal segmental glomerulosclerosis.
Diagnostic / clinical pearl
Multiple or unusual thrombotic events accompanied by substantial proteinuria should prompt evaluation for underlying glomerular disease, including kidney biopsy when indicated.