Renal Vein Thrombosis
Clotting in the renal vein, or renal vein thrombosis, produces renal congestion, engorgement and, sometimes, infarction. Thrombosis may affect both kidneys and occurs in an acute or a chronic form.
Chronic thrombosis usually impairs renal function, causing nephrotic syndrome. If thrombosis affects both kidneys, the prognosis is poor. Thrombosis that affects only one kidney, or gradual progression that allows development of collateral circulation, may preserve partial renal function. The disorder occurs in people of all ages, including infants.
The acute form usually can be recognized and treated before nephrotic syndrome occurs.
Renal vein thrombosis is a fairly uncommon situation that may happen after trauma to the abdomen or back, or it may occur because of a tumor, stricture (scar formation), or other blockage of the vein. It may be associated with nephrotic syndrome.
In some children it occurs after severe dehydration, and is a more serious condition than in adults. Dehydration is the most common cause of renal vein thrombosis in infants.
Signs and Symptoms
Excretory urography provides reliable diagnostic evidence. In acute renal vein thrombosis, the kidneys appear enlarged and excretory function diminishes or is absent in the affected kidney. Contrast medium seems to "smudge" necrotic renal tissue. In chronic renal thrombosis, the test may show ureteral indentations that result from collateral venous channels.
Renal arteriography and biopsy may confirm the diagnosis.
Venography confirms the presence of the occluding thrombosis.
Urinalysis reveals hematuria, oliguria, proteinuria (more than 2 g/24 hours in chronic disease), and casts.
Blood studies show leukocytosis, hypoalbuminemia, hyperlipidemia, and thrombocytopenia.
Gradual thrombosis that affects only one kidney may be treated effectively with anticoagulant therapy (heparin or warfarin), particularly if it's long term and if the thrombus extends into the vena cava. Thrombolytic therapy, using streptokinase or alteplase, also is effective.
Surgery must be performed within 24 hours of thrombosis, but even then it has limited success because thrombi may extend into the small veins. Extensive intrarenal bleeding and severe hypertension in an atrophic kidney may necessitate nephrectomy.
A patient who survives abrupt thrombosis with extensive renal damage develops nephrotic syndrome and requires treatment for renal failure, such as dialysis and, possibly, transplantation. An infant with renal vein thrombosis may either recover completely after rehydration and heparin therapy or surgery, or may suffer irreversible kidney damage. Bilateral damage can be fatal.
PreventionThere is no specific prevention for renal vein thrombosis. Maintaining fluids in the body to avoid dehydration may help to reduce its risk.
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