Renal vein thrombosis (clot in renal vein)

Pelvis | Urology | Renal vein thrombosis (clot in renal vein) (Disease)


Description

Renal vein thrombosis is a blood clot that develops in the vein that drains blood from the kidney. It may present with either chronic bilateral thrombosis or, less often, with acute unilateral or bilateral thrombosis.

Causes and Risk factors

It may be associated with other thromboembolism, including pulmonary embolism. Nephrotic syndrome is the most common cause.

Other causes include: renal cancer, renal transplantation, Behçets disease, hypercoagulable states, antiphospholipid syndrome. In infants, the most common cause is dehydration. Symptoms may be difficult to differentiate from those of the underlying condition, e. g. nephrotic syndrome or renal malignancy.

In the acute status the patient may have loin pain, decline in renal function, haematuria, renal enlargement, asymmetrical leg oedema, increased proteinuria in nephrotic syndrome. Patients with chronic thrombosis may have no symptoms or signs and it is detected by decline in renal function, increase in proteinuria or by being seen on abdominal MRI scan. Other features of both acute and chronic forms are pulmonary emboli, increased peripheral oedema, dilated abdominal veins, left varicocele (if the left renal vein is thrombosed).

Diagnosis and Treatment

Management includes anticoagulation with warfarin. If renal vein thrombosis is associated with pulmonary emboli, anticoagulation should be continued for as long as nephrotic syndrome persists.

Streptokinase may be used to lyse acute thrombosis. Statins, angiotensin-converting enzyme (ACE) inhibitors or angiotensin-II receptor blockers decrease proteinuria from nephrotic syndrome. Decreasing protein loss in the urine decreases hypercoagulability. Surgical treatment is rarely required. ...