A 66-year-old woman with nephrotic syndrome on prednisone presents with cough and dyspnea. Which diagnosis is highly suspected due to the hypercoagulable state associated with nephrotic syndrome?

• A. Pneumonia
• B. Pulmonary embolism
• C. COPD exacerbation
• D. Cushing's syndrome

Answer: (B)

Nephrotic syndrome creates a strong tendency to clotting. The kidneys leak proteins like antithrombin III into the urine, which lowers circulating anticoagulant levels. In response, the liver increases production of clotting factors and fibrinogen, and blood becomes relatively more viscous. This combination markedly raises the risk of venous thromboembolism, including pulmonary embolism.

So when a patient with nephrotic syndrome presents with cough and dyspnea, pulmonary embolism is highly plausible because a PE fits the acute, breathlessness picture and leverages the known hypercoagulable state from nephrotic syndrome. Pneumonia could also cause cough and dyspnea, but the nephrotic-associated thrombotic risk makes a pulmonary embolism the more likely culprit in this context. COPD exacerbation and Cushing’s syndrome do not specifically explain the hypercoagulable tendency seen here.