renal vein thrombosis

Etiology

(risk factors):

• trauma
• extrinsic compression
  • lymph nodes
  • tumor
  • aortic aneurysm
• hypercoagulable states
  • nephrotic syndrome
    • membranous glomerulonephritis
  • invasion by renal cell carcinoma
  • dehydration in infants
  • pregnancy
  • oral contraceptives
  • anti-phospholipid antibody syndrome

Clinical manifestations

• acute cases generally occur in children (case of 50 yo woman)
  • sudden loss in renal function
  • fever/chills
  • lumbar tenderness (with renal enlargement)
  • leukocytosis
  • hematuria
  • flank pain
• subacute renal deterioration
  • in setting of risk factors(s) (see etiology)
  • exacerbation of nephrotic syndrome
  • hematuria
• indolent cases may occur in elderly
  • pulmonary emboli
  • hypertension
• other
  • Fanconi syndrome
  • proximal renal tubular acidosis
  • palpable abdominal mass(es) not a feature

Laboratory

• elevated serum lactate dehydrogenase
• elevated serum creatinine
• CBC: leukocytosis
• urinalysis: hematuria, leukocytouria, proteinuria (albuminuria)

Radiology

• renal ultrasound
• magnetic resonance
• selective renal venography
• CT angiography (initial diagnostic test)

Complications

• systemic thromboembolism
• hemorrhagic infarction
• rupture of kidney
• hypovolemic shock

Differential diagnosis

• nephrolithiasis
  • serum lactate dehydrogenase not elevated
  • acute kidney injury if bilateral ureteral obstruction & hydronephrosis
  • nephrotic syndrome not a general feature
• renal papillary necrosis
  • severe analgesic nephropathy

Management

• anticoagulation to prevent pulmonary emboli
• streptokinase
• nephrectomy in infants with renal infarction
• thrombectomy

More general terms

• splanchnic vein thrombosis (SVT)
• renal vascular disease