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Renal Vein Thrombosis

Clotting in the renal vein results in renal congestion, engorgement and, possibly, infarction. Renal vein thrombosis may affect both kidneys and may occur in an acute or chronic form.

Chronic thrombosis usually impairs renal function, causing nephrotic syndrome. Abrupt onset of thrombosis that causes extensive damage may precipitate rapidly fatal renal infarction.

If thrombosis affects both kidneys, the prognosis is poor. However, less severe thrombosis that affects only one kidney or gradual progression that allows development of collateral circulation may preserve partial renal function.

Causes

Renal vein thrombosis often results from u tumor that obstructs the renal vein ( usually hypernephroma).

Other causes include thrombophlebitis of the inferior vena cava (may result nom abdominal trauma) or blood vessels of the legs, heart failure, and periarteritis. In infants, renal vein thrombosis usually follows diarrhea that causes severe dehydration. Chronic renal vein thrombosis is often a complication of other glomerulopathic diseases, such as amyloidosis, systemic lupus erythematosus, diabetic nephropathy, and membranoproliferative glomerulonephritis.

Signs and symptoms

• Flank pain or low back pain , may be severe
• Urine, bloody
• Urine output, decreased

Diagnosis

Renal venography , where a contrast material (dye) is injected into the renal vein before x rays are taken, is one of the best ways to detect renal vein thrombosis. Other useful tests to detect a clot include computed tomography scans (CT scans), magnetic resonance imaging (MRI), and ultrasound.

Treatment

Gradual thrombosis that affects only one kidney responds best to treatment. Anticoagulant therapy may prove helpful, especially if used long-term.

Surgery must be performed within 24 hours of thrombosis but even then has limited success because thrombi often extend into the small veins. Extensive intrarenal bleeding may necessitate nephrectomy.

Patients who survive abrupt thrombosis with extensive renal damage develop nephrotic syndrome and require treatment for renal failure, such as dialysis and possible transplantation. Some infants with renal vein thrombosis recover completely after heparin therapy or surgery; others suffer irreversible kidney damage.

Prevention

There is no specific prevention for renal vein thrombosis. Preventing dehydration reduces the risk that it will occur.