Diagnostic Challenges in Nephrotic Syndrome Presenting With Venous Thromboembolism

Nephrotic syndrome (NS) has a well-established relationship with hypercoagulability and, while rare, is known to present with unprovoked venous thromboembolism (VTE). Here, we present a case of seemingly unprovoked deep vein thrombosis and pulmonary embolism as presenting features of NS. We explore the challenge of timing diagnostic renal biopsy with necessary therapeutic anticoagulation, particularly in patients who present with unstable or extensive VTE. We also examine relevant factors in selecting an anticoagulant and discuss emerging treatment modalities in NS. This case underscores the complexity of medical decision-making in NS presenting with VTE and highlights the importance of multi-disciplinary consideration of patient-specific risks and benefits.