Superior mesenteric vein thrombosis in a patient with primary focal segmental glomerulosclerosis

Abstract Introduction: Nephrotic syndrome creates a hypercoagulable state that predisposes patients to venous thromboembolism. Mesenteric vein thrombosis associated with minimal change disease and membranous nephropathy has rarely been reported. Few cases of mesenteric vein thrombosis have been reported in some types of nephrotic syndrome; however, isolated mesenteric vein thrombosis has not been previously reported in adults with nephrotic syndrome due to focal segmental glomerulosclerosis. Patient concern: A 19-year-old man with biopsy-proven primary focal segmental glomerulosclerosis was in partial disease remission when he presented with postprandial abdominal pain four months after starting prednisone therapy. Diagnosis: Abdominal computed tomography revealed subacute superior mesenteric vein thrombosis complicated by distal ileum ischemia. Intervention: The patient was treated with low-molecular-weight heparin and bridged with warfarin. Prednisone therapy was continued for the underlying nephrotic syndrome. Outcomes: The patient's symptoms improved with conservative management. He continued to be asymptomatic at subsequent follow-up visits, with no reported complications or medication side effects. Conclusion: This unique case of superior mesenteric vein thrombosis in an adult with nephrotic syndrome due to primary focal segmental glomerulosclerosis in partial remission diagnosed on computed tomography was treated conservatively with anticoagulation therapy. The findings in this case suggest that in patients with nephrotic syndrome, hypercoagulability may extend beyond the acute stage of the disease despite treatment.