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?
- A)Increased fibrinolytic activity in nephrotic glomeruli
- B)Direct inhibition of Factor V by immune complexes
- C)Loss of plasma anticoagulants in urine due to proteinuriaGABARITO
- D)Enhanced endothelial production of prostacyclin
- E)Decreased platelet aggregation from immune complex deposition
Explicação
Nephrotic syndrome increases thrombotic risk through urinary losses of anticoagulant proteins (antithrombin III, protein C, protein S, plasminogen) in the proteinuria, combined with increased hepatic synthesis of procoagulant factors (fibrinogen, factors II, V... Ver explicação completa e trilha adaptativa →