Thrombosis praecox: Thromboembolic complication preceding the onset of overt Nephrotic syndrome in a patient with Membranous Nephropathy

Thromboembolism is a well-recognized complication of Nephrotic syndrome. In adults, most thromboembolic events occur following the diagnosis of Nephrotic syndrome or during relapses. There is a paucity of literature describing thromboembolic events preceding the appearance of overt nephrotic state. Unless a high index of suspicion is maintained, the diagnosis of Nephrotic syndrome could be missed. We describe a patient of Primary Membranous Nephropathy whose clinical course was marked by thrombotic events - Pulmonary embolism and brachial artery thrombosis, occurring six months prior to the presentation with Nephrotic syndrome.