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Renal Vein Thrombosis: Symptoms, Diagnosis and Treatment

Definition

Renal vein thrombosis is the formation of a thrombus in the renal vein with the risk of acute renal failure.

Etiology (Causes) of Renal Vein Thrombosis

Causes and pathophysiology of renal vein thrombosis are comparable to deep venous thrombosis (Virchow triad), often a combination of causes are found:

• Endothelial damage: trauma, renal transplant, infiltration by tumor.
• Stasis: risk factors for renal vein thrombosis include perinatal asphyxia, hypotension or cyanotic heart diseases. Compression of the renal vein by retroperitoneal tumors or other retroperitoneal diseases. Severe dehydration.
• Hypercoagulopathia: nephrotic syndrome, thrombophilia syndromes.

Signs and Symptoms

• Flank pain
• Hematuria
• A painful flank tumor by renal enlargement may be palpable.
• Acute renal failure: decreased urine production (oliguria/anuria)

Diagnostic Workup of Renal Vein Thrombosis

Laboratory tests:

Urine analysis: hematuria and proteinuria. Blood tests: eventually increased creatinine and potassium in serum.

Renal ultrasound:

Renal ultrasound is important for differential diagnosis of acute renal failure: e.g., exclusion of hydronephrosis. Signs of renal vein thrombosis are kidney enlargement and the detection of a renal vein thrombus in Doppler sonography. The renal vein thrombus may extend into the inferior vena cava.

CT or MRI Abdomen:

CT scan or MRI of the abdomen is reliable for diagnosing renal vein thrombosis.

Treatment of Renal Vein Thrombosis

• Immediate parenteral anticoagulation with heparin.
• After the acute phase, oral anticoagulation with, e.g., warfarin is necessary. The duration depends on the risk profile and the remaining renal function.
• Treatment of the underlying disease (e.g., nephrotic syndrome).
• Percutaneous endovascular or surgical interventions and thrombolysis are an option in highly selected patients with acute renal failure (bilateral thrombosis), renal transplant, persistent flank pain, or contraindications to anticoagulation.

References

M. Asghar, K. Ahmed, S. S. Shah, M. K. Siddique, P. Dasgupta, and M. S. Khan, “Renal vein thrombosis.,” Eur. J. Vasc. Endovasc. Surg., vol. 34, no. 2, pp. 217–223, 2007.

  Deutsche Version: Nierenvenenthrombose