{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T13:21:26Z","timestamp":1775827286177,"version":"3.50.1"},"reference-count":7,"publisher":"SMC Media","issue":"4","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Introduction:\u00a0Nephrotic syndrome is a well-recognised risk factor for venous thromboembolism (VTE) but may present without oedema, hyperlipidaemia or impaired kidney function, delaying diagnosis. Case description:\u00a0A 73-year-old man presented with fatigue, exertional dyspnoea and weight loss over a period of three months. Computed tomography pulmonary angiography showed bilateral central pulmonary emboli. Cardiac biomarkers were elevated with preserved renal function. Therapeutic anticoagulation was initiated. To assess thrombus extent and guide management, lower limb compression ultrasonography was performed and revealed bilateral popliteal deep vein thrombosis. Urinalysis demonstrated nephrotic-range proteinuria (8 g\/day) with hypoalbuminaemia and microscopic haematuria. Evaluation for other secondary causes of thrombembolism was unremarkable. Anti-phospholipase A2 receptor and thrombospondin type-1 domain-containing 7A antibodies were negative. Corticosteroid treatment was commenced. A transjugular kidney biopsy confirmed membranous nephropathy, and rituximab was administered for long-term immunosuppressive management. Discussion:\u00a0This case illustrates that nephrotic syndrome can be clinically occult and should be considered in unprovoked or extensive VTE, particularly when bilateral deep vein thrombosis is present. Conclusion:\u00a0Urine dipstick testing, and serum albumin should be considered early in the work-up of unexplained VTE, even in the absence of oedema or reduced estimated glomerular filtration rate.<\/jats:p>","DOI":"10.12890\/2026_006359","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T13:54:50Z","timestamp":1775570090000},"source":"Crossref","is-referenced-by-count":0,"title":["Unprovoked pulmonary embolism with bilateral deep vein thrombosis revealing occult nephrotic syndrome due to seronegative membranous nephropathy"],"prefix":"10.12890","volume":"13","author":[{"given":"Seyma","family":"Eser","sequence":"first","affiliation":[{"name":"Departement of Internal Medicine, Hirslanden Clinic, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Serra","sequence":"first","affiliation":[{"name":"Nephrology and Dialysis, Hirslanden Clinic, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martina","family":"Kleber","sequence":"first","affiliation":[{"name":"Departement of Internal Medicine, Hirslanden Clinic, Zurich, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felix","family":"Brombacher","sequence":"first","affiliation":[{"name":"Departement of Internal Medicine, Hirslanden Clinic, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10397","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"10.12890\/2026_006359_ref1","doi-asserted-by":"crossref","unstructured":"Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J 2019;54:1901647. doi: 10.1183\/13993003.01647-2019","DOI":"10.1183\/13993003.01647-2019"},{"key":"10.12890\/2026_006359_ref2","doi-asserted-by":"crossref","unstructured":"F\u00fcrbringer-Schwarz A, Janscak M, Jeanneret-Gris CR. Outcome after bilateral deep vein thrombosis. Vasa 2022;51:372-376. doi: 10.1024\/0301-1526\/a001030","DOI":"10.1024\/0301-1526\/a001030"},{"key":"10.12890\/2026_006359_ref3","doi-asserted-by":"crossref","unstructured":"Kerlin BA, Ayoob R, Smoyer WE. Epidemiology and pathophysiology of nephrotic syndrome-associated thromboembolic disease. Clin J Am Soc Nephrol 2012;7:513-520. doi: 10.2215\/CJN.10131011","DOI":"10.2215\/CJN.10131011"},{"key":"10.12890\/2026_006359_ref4","doi-asserted-by":"crossref","unstructured":"Mahmoodi BK, ten Kate MK, Waanders F, Veeger NJ, Brouwer JL, Vogt L, et al. High absolute risks and predictors of venous and arterial thromboembolic events in patients with nephrotic syndrome: results from a large retrospective cohort study. Circulation 2008 Jan;117:224-230. doi: 10.1161\/CIRCULATIONAHA.107.716951","DOI":"10.1161\/CIRCULATIONAHA.107.716951"},{"key":"10.12890\/2026_006359_ref5","doi-asserted-by":"crossref","unstructured":"van de Logt AE, Fresquet M, Wetzels JF, Brenchley P. The anti-PLA2R antibody in membranous nephropathy: what we know and what remains a decade after its discovery. Kidney Int 2019;96:1292-1302. doi: 10.1016\/j.kint.2019.07.014","DOI":"10.1016\/j.kint.2019.07.014"},{"key":"10.12890\/2026_006359_ref6","doi-asserted-by":"crossref","unstructured":"Sethi S, Beck LH Jr, Glassock RJ, Haas M, De Vriese AS, Caza TN, et al. Mayo Clinic consensus report on membranous nephropathy: proposal for a novel classification. Kidney Int 2023;104:1092-1102. doi: 10.1016\/j.kint.2023.06.032","DOI":"10.1016\/j.kint.2023.06.032"},{"key":"10.12890\/2026_006359_ref7","doi-asserted-by":"crossref","unstructured":"Ou JY, Chen YW, Li TL, Shan HZ, Cui S, Lai JJ, Xiao Y. Evaluation of efficacy of rituximab for membranous nephropathy: A systematic review and meta-analysis of 11 studies. Nephrol Ther 2022;18:104-112. doi: 10.1016\/j.nephro.2021.10.002","DOI":"10.1016\/j.nephro.2021.10.002"}],"container-title":["European Journal of Case Reports in Internal Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/6359\/5371","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/6359\/5372","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/6359\/5372","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T12:10:12Z","timestamp":1775823012000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/view\/6359"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":7,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.12890\/2026_006359","relation":{"has-manifestation":[{"id-type":"other","id":"1-166-6359-g5371","asserted-by":"subject"},{"id-type":"other","id":"1-166-6359-g5372","asserted-by":"subject"}],"is-part-of":[{"id-type":"other","id":"1-166","asserted-by":"subject"}]},"ISSN":["2284-2594"],"issn-type":[{"value":"2284-2594","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,1]]}}}