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Renal vein thrombosis (RVT) associated with nephrotic syndrome (NS) in patients with flank pain is rarely the earliest manifestation. Despite the absence of formal guidelines, treatment generally consists of prophylaxis against new thrombotic events and clot dissolution (thrombolysis) or clot removal (thrombectomy). We describe the case of a 25-year-old woman with lumbar pain, nausea and vomiting, who developed nephrotic proteinuria, macroscopic hematuria and loss of renal function requiring hemodialysis without improvement with methylprednisolone and cyclophosphamide. Considered diagnoses of systemic lupus erythematosus (SLE) and antiphospholipid antibody syndrome (APS). Angiotomography showed subacute vena cava thrombosis with extension to the two renal veins. Alteplase thrombolysis was performed to recovery of renal function. Patient progressed with improvement of renal function and discontinuation of hemodialysis. In conclusion, late thrombolysis may be effective for subacute RVT in NS patients. A trombose venosa renal (RVT) associada à síndrome nefrótica (SN) em pacientes com dor no flanco raramente é a manifestação mais precoce. Apesar da ausência de diretrizes formais, o tratamento geralmente consiste em profilaxia contra novos eventos trombóticos e dissolução do coágulo (trombólise) ou remoção do coágulo (trombectomia). Descrevemos o caso de uma mulher de 25 anos com dor lombar, náusea e vômito, que desenvolveu proteinúria nefrótica, hematúria macroscópica e perda da função renal, necessitando de hemodiálise sem melhora com metilprednisolona e ciclofosfamida. Considerados diagnósticos de lúpus eritematoso sistêmico (LES) e síndrome do anticorpo antifosfolípide (SAF). A angiotomografia mostrou trombose da veia cava subaguda com extensão para as duas veias renais. A trombólise com alteplase foi realizada para recuperação da função renal. O paciente evoluiu com melhora da função renal e descontinuação da hemodiálise. Em conclusão, a trombólise tardia pode ser eficaz para a RVT subaguda em pacientes com SN.

Hypercalcemia caused by tuberculosis is rare and it is usually asymptomatic. Tuberculosis (TB) -related hypercalcemia associated with acute kidney injury (AKI) is rarely reported. We report a case of a 22-year-old immunocompetent man with 1-month history of daily fever, asthenia and weight loss. Laboratory findings on admission included serum calcium 14.9 mg/dL, urinary Ca(2+) 569.6 mg/24 hours, low level of parathyroid hormone, serum creatinine = 2.2 mg/dL and sodium fractional excretion (FeNa) 2.73%. The result of the tuberculin skin test was 17 mm. A chest X-ray revealed micronodular pulmonary infiltrate in the apex of the right lung, which was confirmed by computed tomography scan. The patient was diagnosed with hypercalcemia associated with pulmonary TB and AKI. A general improvement of the hypercalcemia and renal function was observed in the first 2 weeks after effective hydration and treatment of TB without corticosteroids. The patient was discharged with normal calcium levels and renal function.