Although nephrotic syndrome has been recognized as a risk factor for venous thromboembolism, the prevalence of pulmonary embolism pe, renal vein thrombosis rvt, and deep vein thrombosis in patients with nephrotic syndrome is based on data in case series that mostly were reported more than a decade ago 2 9. A 31yearold male with known atresia of the inferior vena cava who received a deceased donor renal transplant 7 years previously presented to hospital with severe graft site pain and a week of nausea, vomiting, and chills. Normally, kidneys rid the body of wastes by filtering the wastes into the bladder where they exit the body through. Previous abdominal ultrasonography and hepatobiliary iminodiacetic acid scan imaging had not demonstrated a clear cause. Acute bilateral renal vein thrombosis american journal. Furthermore, the administered anticoagulation therapy for renal vein thrombosis may have exacerbated the pulmonary hemorrhage and eventual degree of respiratory failure. Case presentation the renal vein thrombosis rvt is a rare pathology in adults as compared to children. In most cases, there is no specific way to prevent renal vein thrombosis. This article requires you to have a account to view the full text. Delayed diagnosis and treatment of rvt can result in catastrophic complications, including loss of renal function and pulmonary embolism. Renal vein thrombosis european journal of vascular and. There are two renal veins left and right that are responsible for draining oxygendepleted blood from the kidneys. One was associated with severe placental dysfunction and demonstrated haematuria and renal failure which resolved on day 10. Almost two thirds of patients have bilateral renal vein involvement.
A 38yearold woman presented with flank pain and hematuria suggestive of renal calculus on ultrasound. Sonographic findings in fetal renal vein thrombosis. Regarding this condition, we present the case of a 63yearold man who had repeatedly visited the emergency room suffering from abdominal and back pain and painful lower limb edema. The other followed an antepartum haemorrhage and resolved before the baby was born. Transplant renal vein thrombosis in a recipient with. Renal vein thrombosis kidney and urinary tract disorders. The presenting symptoms of acute renal vein thrombosis rvt can often be confused with those of nephrolithiasis. Portal vein thrombosis pvt is a blood clot that causes irregular blood flow to the liver. In the primary type, usually seen during infancy, extrinsic factors do not give rise to the thromboses. Clinical symptoms are variable and may be often masked by. In summary, renal vein thrombosis secondary to nephrosis is an unusual but important initial presentation of goodpastures syndrome.
Renal vein thrombosis is thrombotic occlusion of one or both main renal veins, resulting in acute kidney injury or chronic kidney disease. During the procedure the pressure in pelvis was higher than we normally use, so this could be considered as risk factor. Renal vein thrombosis develops when a blood clot forms in the renal vein, which is the blood vessel that carries blood from the kidneys back to the heart. In adults, onset and progression are usually gradual and without symptoms. Renal vein thrombosis in a transplanted kidney is an uncommon but critical complication that can result in graft loss if management is delayed. A case report and a descriptive retrospective study of. Renal vein thrombosis rvt in adults can occur in association with or as a consequence of severe nephrotic syndrome, renal cell carcinoma, trauma, infection, and a variety of systemic hypercoagulable states. Acute bilateral renal vein thrombosis american journal of kidney. In any patient with loin pain, acute scrotal swelling and a varicocoele, evaluation of the abdomen and retroperitoneum for underlying malignancy and. Pdf patients with nephrotic syndrome presents a high risk of arterial and venous thrombosis, mainly deep vein thrombosis and renal vein. Renal vein thrombosis nephrology grand rounds 101811 nicola sumorok. In the latter variety, the diagnosis is often made only at necropsy with the pathologist finding signs of incipient renal vein thrombosiswhichis attributed tomarasmus. It is usually present as a complication of other conditions as sepsis, hypercoagulable state, and malignancy. Left renal vein thrombosis can present with acute scrotal pain and a unilateral varicocoele.
Renal vein thrombosis and pulmonary embolism cleveland. Increased renal size, altered echogenicity, loss of corticomedullary demarcation, enlargement of the renal vein and demonstration of a thrombus are indicative but non specific ultrasonographic findings of renal vein thrombosis. Risk of both arterial and venous thrombosis is higher in patients with nephrotic syndrome compared to the general population. A 61yearold caucasian male, with history of hypertension, diabetes, obesity, deep venous thrombosis with. Introduction renal vein thrombosis rvt is a complication of diseases such as renal cancer, lupus nephritis and acute pyelonephritis. In the july issue, llach, arieff, and massry 1 reported from a careful, prospective study that they had detected an alarmingly high incidence 33% of renal vein thrombosis in patients with the nephrotic syndrome, which in most cases was secondary to membranous and membranoproliferative glomerulonephritis. These two distinct clinical entities led sandblom 1948 to.
This was followed in 1877 by hutinels account of fortytwo cases of renal thrombosis, in thirty of which the condition was bilateral. Renal vein thrombosis an overview sciencedirect topics. Because of pscaih overlap syndrome coagulation disorders were expected but rather bleeding longer ptt, thrombocytopenia than thrombosis. Renal vein thrombosis may occur bilaterally in 24% of newborns with almost half extending into the ivc. Patients with nephrotic syndrome frequently have renal. Renal vein thrombosis rvt is a blood clot that develops in one or both of the renal veins. Renal vein thrombosis rvt with flank pain, and hematuria, is often mistaken with renal colic originating from ureteric or renal calculus. Common causes include nephrotic syndrome, primary hypercoagulability disorders, malignant renal tumors, extrinsic compression, trauma, and rarely inflammatory bowel disease. It is a more difficult problem, however, to suspect this condition on the basis of simpler roentgenographic procedures and to refer suitable candidates for definitive angiographic study. Renal vein thrombosis has been underdiagnosed because of its variable clinical and radiological findings but it becomes a more frequently recognizable clinical entity since diagnosis can be easily established by modern angiographic techniques. Bilateral renal vein thrombosis can cause nephrotic range.
Thrombosis of the renal veins associated with the nephrotic syndrome has been recognized since 1939. An occasional clue to doctors is when a piece of clot breaks off and travels from the renal vein to the lungs pulmonary embolism. The risks of renal vein thrombosis include perinatal asphyxia, shock, polycythemia, cyanotic congenital heart disease, maternal diabetes, and sepsis, which result in reduced renal flow, hyperviscosity, hyperosmolality, and hypercoagulability. Sonographic findings in fetal renal vein thrombosis eonatal renal vein thrombosis is an uncommon entity with relatively low mortality but high morbidity,1,2 with an esti mated incidence of 2. Pdf renal vein thrombosis and membranous nephropathy. The majority of venous thrombotic events involve the extremities, although venous thrombosis may occur at any location, including organ veins. Both arterial and venous thrombosis may occur and systemic cerebral involvement very common as well as peripheral vessels are involved. In a patient with lupus, the appearance of sudden unexplained flank pain should raise suspicion for renal vessel thrombosis, of which renal vein thrombosis is more common than arterial. This event causes sudden pain in the chest that is made worse by breathing, along with shortness of breath. Renal vein thrombosis is a condition characterized by renal dysfunction secondary to a clot blocking the renal vein, which drains blood from the kidney. In cases of unilateral thrombosis the left renal vein is affected more commonly than the right. Thrombosis ofthe renal vein was first described by rayer in 1837. Keeping enough fluids in the body may help reduce risk.
Renal vein thrombosis genitourinary disorders merck. Published experience regarding the clinical course and management of. Renal vein thrombosis in chinese patients with systemic. Renal vein thrombosis is not common and can cause serious damage to the kidneys. A variety of mri techniques timeofflight tof, black blood, and delayed gd. Some experts suggest a dose reduction should be considered if the trough antixa level is 0. Renal vein thrombosis etiology, diagnosis, therapeutic options. Nephrotic syndrome associated with renal vein thrombosis. Neonatal renal vein thrombosis rvt is associated with potentially serious morbidities. Blood thinners such as warfarin may be recommended for some people with chronic kidney disease. Imaging teaching case acute bilateral renal vein thrombosis qi qian, md,1,2 nathan a. Two cases of fetal renal vein thrombosis, diagnosed via maternal ultrasound scan are presented. Renal vein thrombosis rvt is the formation of a clot in the vein that drains blood from the kidneys, ultimately leading to a reduction in the drainage of one or both kidneys and the possible migration of the clot to other parts of the body. You do not have access to the full text of this article, the first page of the pdf of this article appears above.
It is typically seen in patients suffering from nephrotic syndrome, but may also be diagnosed in individuals with renal malignancies, and hypercoagulable states. A 31yearold male with known atresia of the inferior vena cava who received a deceased donor renal transplant. With the availability of modern angiographic technics, it has become a simple matter to establish the diagnosis of thrombosis of the renal veins. The thrombotic process is initiated in the renal vein or the intrarenal tributaries. Renal vein thrombosis rvt is a rare event with myriad clinical manifestations. Generally it has been believed that renal vein thrombosis may cause nephrotic syndrome. On the other hand late renal vein thrombosis have been re ported in association with recurrent or denovo membra. Renal vein thrombosis rvt, the presence of thrombus in the major renal veins or its tributaries, is a rare clinical entity. This is the reason why, although the diagnosis is challenging, a high index of suspicion is required. Methods data on clinical symptoms, renal biopsy, antiphospholipid antibody syndrome profile, and serological examinations of lupus features were examined retrospectively in six patients with rvt. Renal allograft thrombosis in the early post transplant period. 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. Fetal renal vein thrombosis furness 1988 australian. The syndrome is responsible for a hypercoagulable state.
Aspirin is sometimes used to prevent renal vein thrombosis in people who have had a kidney transplant. Abdominopelvic computed tomographic scan revealed an enlarged right kidney and an atretic right renal vein secondary to thrombosis, as well as sclerosis with draining retroperitoneal venous varices image a, arrow. Pediatric renal vein thrombosis the journal of the. Learn about the symptoms and treatment of this condition. That patients with nephrotic syndrome are at an increased risk of developing renal vein thrombosis rvt is well established. Early renal vein thrombosis often results from poor surgical technique, perigraft fluid collection, compres sion of the common iliac veins and hypovolemia 3. This condition may either present with acute symptoms or go unnoticed because of lack of symptoms until a complication like pulmonary embolism or worsening renal function, draws attention to it. Inferior vena cava thrombosis is an underrecognized entity associated with significant morbidity and mortality. Clinical notes renal vein thrombosis in infants louis a. Especially in young and otherwise healthy patients, clinicians are easily misled by clinical presentation and calcified rvt. Objectives to evaluate the risk factors associated with renal vein thrombosis rvt in chinese patients with systemic lupus erythematosus sle.
1267 125 1582 895 1556 871 223 460 850 628 1030 755 1312 971 399 915 494 1320 245 213 1514 1105 1660 745 832 1592 517 60 1351 558 1266 891 420 528 1353 63 812 447 404 1158 651 1008 634 131