Glomerular Diseases USMLE Step 1 Practice Question
A 68-year-old woman with membranous nephropathy presents with nephrotic syndrome, new-onset atrial fibrillation, and dyspnea. Vital signs show BP 156/94, HR 118, RR 22, SpO2 88%. Serum albumin is 1.8 g/dL with 24-hour urine protein 8.5 g. D-dimer is elevated at 2.1 μg/mL. CT angiography reveals right renal vein thrombosis. She denies recent surgery or trauma. Which mechanism best explains her increased thrombotic risk?
Answer choices
- AIncreased fibrinolytic activity in nephrotic glomeruli
- BDirect inhibition of Factor V by immune complexes
- CLoss of plasma anticoagulants in urine due to proteinuriaCorrect answer
- DEnhanced endothelial production of prostacyclin
- EDecreased platelet aggregation from immune complex deposition
- FIncreased hepatic synthesis of prothrombotic clotting factors secondary to hypoalbuminemia
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