Stroke in a young adult associated with primary membranous nephropathy: case report.

Abstract

Introduction. Stroke in young individuals is becoming increasingly prevalent worldwide. Its causes can vary widely, necessitating thorough investigation by a multidisciplinary team. Pinpointing the precise underlying pathology responsible for the stroke yields significant benefits for patients, particularly in recurrent events.
Case presentation. A 38-year-old man presented to the emergency department with symptoms suggestive of stroke, including right hemiparesis, dysarthria, ataxic gait, and right central facial palsy. Brain MRI revealed an ischemic lesion located in the left basal ganglia and near the corona radiata. Following an extensive work-up, a diagnosis of nephrotic syndrome was established. Through histopathology examination and the exclusion of secondary causes, primary membranous nephropathy was confirmed as the underlying condition.
The patient underwent treatment tailored to address the specific glomerulopathy, along with anticoagulation therapy and immunosuppression as per current guidelines. Subsequent assessments showed stabilization of renal function, resolution of edema, and the absence of new thromboembolic events during follow-up.
Conclusion. Nephrotic syndrome should be recognized as a potential underlying cause of stroke in young patients, and therefore, it should be included in the differential diagnosis during the evaluation of patients with coagulopathies. Screening for nephrotic syndrome can be facilitated by conducting a simple urinalysis, a diagnostic tool readily available in most healthcare facilities. This highlights the importance of considering renal pathology in the assessment of stroke etiologies, especially when coagulation abnormalities are present.