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Patients with nephrotic syndrome frequently have renal-vein thrombosis (RVThromb) without overt clinical manifestations. At the onset of the condition only 10% of these patients have acute signs and symptoms such as flank pain, haematuria, proteinuria and a rapid decline of renal function [1]. Patients experiencing severe flank pain, a rapid deterioration of renal function and concomitant pulmonary emboli or multiple thrombi have been successfully managed with thrombolytic agents [3], despite the fact that the risk associated with thrombolytic therapy seems to be greater than that of anticoagulant therapy, which would appear to be a more appropriate choice of treatment. Since low-molecular-weight heparins (LMWHep) have a longer half-life and better bioavailability than unfractionated heparin, they are widely used for treating many clinical conditions [4]. This case report confirms that LMWHep can be used successfully to treat the RVThromb of a nephrotic patient. It also suggests that such therapy may be applied even when thrombolytic or other anticoagulation therapy has previously failed.

The successful treatment of renal-vein thrombosis by low-molecular-weight heparin in a steroid-sensitive nephrotic patient