CONSULT ROUNDS

Lets discuss Renal Vein Thrombosis in a Membranous GN .
What to we do? Some points that were discussed!
1. Anticoagulation with warfarin vs Lovenox
2. Sometimes surgery is required and thrombectomy is done. Rarely!
3. When do we use thrombolytics?  Apparently based on few case series and case reports, to use it when there is active clot, flank pain, and no contra indication of recent bleeding and there is a worsening renal function.
4. If their proteinuria is controlled well with ACEI or ARBS, and if they still get a pulmonary embolism, deep venous thrombosis or renal vein thrombosis, do you start treating the Membranous glomerulopathy  with immunosuppresive therapy? No evidence for that? But perhaps we should be or should perhaps look for a secondary cause of that membranous, perhaps a cancer!!