A 19 year lady presents gross oedema frothy urine. She investigated found have an albumin of 10 heavy proteinuria of 11.5g/l a Cholesterol of 9. She undergoes a renal biopsy diagnosised as having Minimal Change nephropathy. She initially goes into remission oral prednisolone but on withdrawal of pteriods relapses quickly. She readmitted a painful left leg further significant oedema. D Dimers are elevated a deep vein thrombosis extending her external iliac vein diagnosised on doppler ultrasonography. She commenced on Heparin but symptoms fail respond. She back on oral Prednisolone diurectics. Her albumin remains at 20. On examination she gross oedema of both legs some mild facial swelling. Her Left leg painful erythematous a dusky hue. JVP raised. Her BP lying 110/70 standing 102/62. Investigations show: APTT ratio 1.86 INR 1.5 What is the likely diagnosis?
1 ) Antithrombin III deficiency
2 ) Hodgkin‟s Disease
3 ) Dehydration
4 ) Inadequate Heparin
5 ) Anti phospholipid Syndrome
Comments: ATIII deficiency likely as Nephrotics often lose Antithrombin in urine. Hodgkins Disease can cause Minimal change disease but there nothing in history suggest this. She postural drop so dehydration unlikely in presence of oedema. Anti phospholipid syndrome does cause minimal Change nephropathy