44

The underlying causes of nephrotic syndrome (NS) include primary and secondary glomerulonephritis, where membranous nephropathy (MN, also known as extramembranous glomerulonephritis) is the most common cause in non-diabetic Caucasian adults over 40 years of age. Although it was recognized as a distinct clinical-pathological entity in 1940 using immunofluorescence and electron microscopy, its pathogenesis and treatment have only become more apparent in the last decade. The discovery of M-type phospholipase A2 receptor (PLA2R) antibodies has provided new perspectives for understanding the pathogenesis of the disease process. Increased thromboembolic risk is a well-recognized complication of NS and MN, with variable reported incidence of deep vein thrombosis based on data in case series that were mostly reported more than a decade ago. The pathophysiology of hypercoagulability in NS is due to an imbalance of prothrombotic and antithrombotic factors, as well as impaired thrombolytic activities. Despite the well-established risk of venous thromboembolism (VTE) in NS, the most effective method of VTE prophylaxis is unclear. We discuss the key questions when it comes to anticoagulant prophylaxis in adults with NS.