{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T16:07:28Z","timestamp":1786982848350,"version":"build-2736575974"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2018,11,12]],"date-time":"2018-11-12T00:00:00Z","timestamp":1541980800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"},{"start":{"date-parts":[[2018,11,12]],"date-time":"2018-11-12T00:00:00Z","timestamp":1541980800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2018,11,12]],"date-time":"2018-11-12T00:00:00Z","timestamp":1541980800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["U54DK083912"],"award-info":[{"award-number":["U54DK083912"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"crossref","award":["U54DK083912"],"award-info":[{"award-number":["U54DK083912"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Clinically apparent venous thromboembolism (VTE) occurs in approximately 7% of patients with membranous nephropathy. Hypoalbuminemia at diagnosis is an independent risk factor for VTE, and risk increases significantly as albumin falls. Optimal prophylactic and treatment anticoagulation regimens in the nephrotic syndrome remain unproven but novel oral anti-coagulants have become attractive therapeutic options. We describe a patient diagnosed with anti-phospholipase A2 receptor antibody positive membranous nephropathy and recurrent VTE while on therapeutic dosing of apixaban. A direct factor Xa inhibitor, apixaban has been shown to be non-inferior to warfarin for the treatment of VTE in the general population. However, because it is highly protein-bound, apixaban may have altered pharmacokinetics and pharmacodynamics in patients with nephrotic syndrome and hypoalbuminemia. This case report highlights the need for further studies of direct oral anticoagulants to fully assess their effectiveness in this high-risk population.<\/jats:p>","DOI":"10.1007\/s40620-018-0552-9","type":"journal-article","created":{"date-parts":[[2018,11,12]],"date-time":"2018-11-12T09:06:17Z","timestamp":1542013577000},"page":"669-672","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Recurrent venous thromboembolism in primary membranous nephropathy despite direct Xa inhibitor therapy"],"prefix":"10.1093","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9988-8833","authenticated-orcid":false,"given":"Monica L.","family":"Reynolds","sequence":"first","affiliation":[{"name":"Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA 1"},{"name":"UNC Kidney Center, 7024 Burnett-Womack, CB#7155, 27599, Chapel Hill, NC, USA 5"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick H.","family":"Nachman","sequence":"additional","affiliation":[{"name":"Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis, MN, USA 2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micah J.","family":"Mooberry","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA 3"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J.","family":"Crona","sequence":"additional","affiliation":[{"name":"Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA 4"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vimal K.","family":"Derebail","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA 1"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,11,12]]},"reference":[{"issue":"3","key":"2026012107120531500_CR1","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1016\/j.kint.2016.09.048 28065518","article-title":"Membranous nephropathy: integrating basic science into improved clinical management","volume":"91","author":"Cattran","year":"2017","journal-title":"Kidney Int"},{"issue":"2","key":"2026012107120531500_CR2","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1681\/ASN.2016070776 27777266","article-title":"A proposal for a serology-based approach to membranous nephropathy","volume":"28","author":"De Vriese","year":"2017","journal-title":"J Am Soc Nephrol"},{"issue":"1","key":"2026012107120531500_CR3","doi-asserted-by":"publisher","first-page":"43","DOI":"10.2215\/CJN.04250511 22076873","article-title":"Venous thromboembolism in patients with membranous nephropathy","volume":"7","author":"Lionaki","year":"2012","journal-title":"Clin J Am Soc Nephrol"},{"issue":"4","key":"2026012107120531500_CR4","doi-asserted-by":"publisher","first-page":"784","DOI":"10.1016\/j.ekir.2018.02.010 29989039","article-title":"Direct-acting oral anticoagulants as prophylaxis against thromboembolism in the nephrotic syndrome","volume":"3","author":"Sexton","year":"2018","journal-title":"Kidney Int Rep"},{"issue":"1","key":"2026012107120531500_CR5","doi-asserted-by":"publisher","first-page":"739","DOI":"10.3892\/etm.2017.5471 29399079","article-title":"Rivaroxaban for the treatment of venous thromboembolism in patients with nephrotic syndrome and low AT-III: a pilot study","volume":"15","author":"Zhang","year":"2018","journal-title":"Exp Ther Med"},{"issue":"5","key":"2026012107120531500_CR6","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1002\/psp4.12184","article-title":"Population pharmacokinetics, pharmacodynamics, and exploratory exposure-response analyses of apixaban in subjects treated for venous thromboembolism","volume":"6","author":"Byon","year":"2017","journal-title":"CPT Pharmacomet Syst Pharmacol"},{"key":"2026012107120531500_CR7","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1038\/kisup.2012.20","article-title":"Kidney disease: improving global outcomes (KDIGO) glomerulonephritis work group. 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