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Renal vein thromboembolism is a severe complication of nephrotic syndrome. Small thrombus in the intra-kidney venous system cannot be recognized by ultrasonography. The current study was to investigate the kidney pathological features of intra-kidney venous thrombus and their values in clinical practice.   Methods:   Kidney pathological features of glomerular capillary dilatation and congestion, peritubular capillary dilatation and congestion, and intraglomerular neutrophil infiltration were screened and scored during kidney biopsy information interpretation. Eighty-four consecutive patients with these features and primary glomerulonephritis were analyzed, comparing to another 84 control patients without these features who were matched according to the pathological types of glomerulonephritis.   Results:   In the patients with pathological features of suspected intra-kidney venous thrombus, the levels of proteinuria (5.2 vs. 3.2 g/24 h,  p  = 0.005), serum creatinine (80.9 vs. 71.2 μmol/L,  p  < 0.001), platelet count (274.0 vs. 254.5 ×10<sup>9</sup>/L,  p  = 0.020), D-dimer (0.2 vs. 0.2 mg/L,  p  = 0.002), and fibrin degradation products (1.9 vs. 1.0 mg/L,  p  = 0.003) were significantly higher than those in control patients. The levels of serum albumin (24.2 vs. 28.6 g/L,  p  = 0.003) and eGFR (92.1 vs. 103.9 mL/min/1.73 m<sup>2</sup>,  p  < 0.001) were significantly lower. The scores of these pathological features were positively correlated with the levels of D-dimer (r = 0.21,  p  = 0.05). During follow-up, 9 (10.7%) patients with pathological features of suspected intra-kidney venous thrombus developed venous thromboembolism, which was significantly more than that of control patients (0%,  p  = 0.006).   Conclusions:   Kidney pathological features could indicate intra-kidney venous thromboembolism, and their scores represent the possibility of thrombus. The notice of these features may provide clinical alerts for venous thromboembolism possibility.

Kidney Histopathology Features of Suspected Intra-Kidney Venous Thromboembolism in Patients with Primary Glomerulonephritis