Renal vein thrombosis

Changed by Andrew Murphy, 12 Feb 2017

Updates to Article Attributes

Body was changed:

Show markup changes

Renal vein thrombosis (RVT) can be either from "bland" thrombus or tumour thrombus (extension of tumor into the vein). There are numerous aetiologies for bland thrombus, but it most commonly occurs in the hypercoagulable nephrotic syndrome. Renal vein thrombus is commoner on the left side, presumably due to the left renal vein being considerably longer than the right.

Pathology

in children: RVT is the most common vascular condition in the neonatal kidney ¹
- dehydration and sepsis are common underlying factors for renal vein thrombosis
- sickle cell disease ²
- polycythaemia
- maternal diabetes
- indwelling umbilical venous catheters
in adults renal vein thrombosis can result from a variety of disorders, including:
- nephrotic syndrome
- systemic lupus erythematosus
- amyloidosis
- glomerulonephritis
- collagen vascular disease
- diabetes
- renal sepsis (thrombophlebitis)
- tumour thrombus, e.g.
  - renal cell carcinoma
  - lymphoma⁵
  - in rare cases, adrenal carcinoma
trauma is another potential cause of renal vein thrombosis

Complications include pulmonary embolism, renal atrophy, and papillary necrosis. Bland thrombus can coexist with tumour thrombus.

Radiographic features

Ultrasound

Grayscale ultrasound findings include

renal enlargement with hypoechoic cortex from edema (early phase)
decreasing size and increased echogenicity (late)
~~Doppler~~doppler findings include reversal of arterial diastolic flow, absent venous flow, visualization of thrombus within the lumen, high resistance in the renal artery with elevated resistive index

CT

~~Enlarged~~enlarged kidney, may reach to a very large size.
~~Perisistent~~persistent cortical enhancement and lack of parenchymal enhancement.
Asas with venous thrombosis elsewhere, the thrombosis is observed as a filling defect during venous phase imaging following intravenous contrast. Changes in the attenuation, either focal or diffuse, may be present in the end organ kidney due to perfusion abnormalities ³.
~~Collateral~~collateral vessels may appear around the kidney in chronic cases.

MRI

MR venography may be performed, especially if the patient has renal impairment which does not permit the use of intravenous contrast ⁴.

Treatment and prognosis

treatment of nephrotic syndrome: steroids and immune-suppression therapy
treatment of underlying renal cell cancer includes surgery for early-stage disease
anticoagulation therapy

Complications

Recognised complications of RVT include

~~-<li>~~
~~-dehydration and sepsis are common underlying factors for renal vein thrombosis</li>~~
+<li>dehydration and sepsis are common underlying factors for renal vein thrombosis</li>
~~-<li>lymphoma5~~
+<li>lymphoma 5
-<li>Doppler findings include reversal of arterial diastolic flow, absent venous flow, visualization of thrombus within the lumen, high resistance in the renal artery with elevated resistive index</li>
+<li>doppler findings include reversal of arterial diastolic flow, absent venous flow, visualization of thrombus within the lumen, high resistance in the renal artery with elevated resistive index</li>
~~-<li>Enlarged kidney, may reach to a very large size.</li>~~
~~-<li>Perisistent cortical enhancement and lack of parenchymal enhancement.</li>~~
-<li>As with venous thrombosis elsewhere, the thrombosis is observed as a filling defect during venous phase imaging following intravenous contrast. Changes in the attenuation, either focal or diffuse, may be present in the end organ kidney due to perfusion abnormalities 3.</li>
~~-<li>Collateral vessels may appear around the kidney in chronic cases. </li>~~
+<li>enlarged kidney, may reach to a very large size.</li>
+<li>persistent cortical enhancement and lack of parenchymal enhancement.</li>
+<li>as with venous thrombosis elsewhere, the thrombosis is observed as a filling defect during venous phase imaging following intravenous contrast. Changes in the attenuation, either focal or diffuse, may be present in the end organ kidney due to perfusion abnormalities 3.</li>
+<li>collateral vessels may appear around the kidney in chronic cases. </li>

ADVERTISEMENT: Supporters see fewer/no ads

{"current_user":null,"inclusions":[{"imageId":484414,"studyId":10521,"caseSlug":"renal-abscess-and-renal-vein-thrombosis","caption":"Case 1: renal abscess with renal vein thrombosis","thumbnail":"https://prod-images-static.radiopaedia.org/images/484414/5c9a90ef2f9b215716b40b0561c1b4_big_gallery.jpg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":134254,"studyId":8341,"caseSlug":"renal-cell-carcinoma-with-renal-vein-thrombosis-1","caption":"Case 2: renal cell carcinoma with renal vein thrombosis","thumbnail":"https://prod-images-static.radiopaedia.org/images/134254/ba9510244f4cad7683b792c07b64fb_big_gallery.jpg","isStack":true,"diagnosticCertainty":"probable"},{"imageId":1593997,"studyId":15858,"caseSlug":"renal-vein-thrombosis","caption":"Case 3","thumbnail":"https://prod-images-static.radiopaedia.org/images/1593997/4e175eca92f16ed655b507cda6a8a6_big_gallery.jpg","isStack":true,"diagnosticCertainty":"probable"},{"imageId":1167209,"studyId":13974,"caseSlug":"renal-venous-infarct-1","caption":"Case 4: with renal venous infarction","thumbnail":"https://prod-images-static.radiopaedia.org/images/1167209/d0c64dd5f9856e86d932702c11445a9957e8e77a465a62877c021925cef002da_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":1826542,"studyId":17013,"caseSlug":"collateral-circulation-following-left-renal-vein-thrombosis","caption":"Case 5: old RVT with collateral circulation","thumbnail":"https://prod-images-static.radiopaedia.org/images/1826542/34589c5f434af2381e9582f47c760e_big_gallery.jpg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":28555659,"studyId":56966,"caseSlug":"renal-vein-thrombosis-1","caption":"Case 6","thumbnail":"https://prod-images-static.radiopaedia.org/images/28555659/a470c2c9f1f2466d6f9b4dd95e2915_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":30295530,"studyId":59211,"caseSlug":"left-renal-vein-thrombosis","caption":"Case 7","thumbnail":"https://prod-images-static.radiopaedia.org/images/30295530/e48df0c3695c4b6ed38e6b4773d9f2_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":54266551,"studyId":102133,"caseSlug":"thrombosis-in-a-circumaortic-left-renal-vein","caption":"Case 8: in a circumaortic left renal vein","thumbnail":"https://prod-images-static.radiopaedia.org/images/54266551/Anonymize.Seq7.Ser403.Img49_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":62502833,"studyId":137272,"caseSlug":"postpartum-left-ovarian-and-renal-vein-thrombosis","caption":"Case 9: postpartum","thumbnail":"https://prod-images-static.radiopaedia.org/images/62502833/86f0558a62a63a5accfdcf3bd96c254857591d6bd8def1c0000b22610acbba99_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":63000597,"studyId":139385,"caseSlug":"renal-vein-thrombosis-4","caption":"Case 10","thumbnail":"https://prod-images-static.radiopaedia.org/images/63000597/865288a02bdd26566c7104c5358ee1915eb34e11e98859ea5e334e7605155ce7_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":63012182,"studyId":139445,"caseSlug":"bilateral-renal-vein-thrombosis","caption":"Case 11: bilateral renal vein thrombosis","thumbnail":"https://prod-images-static.radiopaedia.org/images/63012182/176fc99e43785ed955986a028ad96d33dc14c12970c5ef0887dd2b42c5835552_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"}],"ddx_inclusions":[{"imageId":1276127,"studyId":14396,"caseSlug":"paroxysmal-nocturnal-haemoglobinuria","caption":"Paroxysmal nocturnal haemoglobinuria","thumbnail":"https://prod-images-static.radiopaedia.org/images/1276127/f37eef85b347afcb9d90eece4c477e_big_gallery.jpg","isStack":false,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":1597482,"studyId":15889,"caseSlug":"renal-artery-thrombosis","caption":" Renal artery thrombosis","thumbnail":"https://prod-images-static.radiopaedia.org/images/1597482/73481c2e18c88f7e251ed3f1d393049392dc5d91f5fc74652d2ca2f9efa43eba_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"}],"lang":"gb"}