Renal vein thrombosis

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Renal vein thrombosis 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, renal vein thrombosis 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
  - lymphoma ⁵
  - 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 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

as with venous thrombosis elsewhere, the thrombosis is observed as a filling defect during venous phase imaging following intravenous contrast
enlarged kidney may reach to a very large size
persistent cortical enhancement and lack of parenchymal enhancement
changes in attenuation, either focal or diffuse, may be present due to perfusion abnormalities ³
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 renal vein thrombosis include:

~~-<li><a title="Polycythaemia" href="/articles/erythrocytosis-1">polycythaemia</a></li>~~
+<li><a href="/articles/erythrocytosis-1">polycythaemia</a></li>
~~-<li><a title="Umbilical venous catheters" href="/articles/umbilical-venous-catheters">indwelling umbilical venous catheters</a></li>~~
+<li><a href="/articles/umbilical-venous-catheters">indwelling umbilical venous catheters</a></li>
~~-<a title="Tumour thrombus" href="/articles/tumour-thrombus">tumour thrombus</a>, e.g.<ul>~~
+<a href="/articles/tumour-thrombus">tumour thrombus</a>, e.g.<ul>
~~-<a title="Lymphoma" href="/articles/lymphoma">lymphoma</a> <sup>5</sup>~~
+<a href="/articles/lymphoma">lymphoma</a> <sup>5</sup>
+<li>urinary obstruction (rare) <sup>6</sup>
+</li>
~~-<li>trauma is another potential cause of renal vein thrombosis</li>~~
-</ul><p>Complications include <a href="/articles/pulmonary-embolism">pulmonary embolism</a>, renal atrophy, and <a href="/articles/renal-papillary-necrosis">papillary necrosis</a>. <a title="Bland thrombus" href="/articles/bland-thrombus">Bland thrombus</a> can coexist with <a title="Tumour thrombus" href="/articles/tumour-thrombus">tumour thrombus</a>.</p><h4>Radiographic features</h4><h5>Ultrasound</h5><p>Grayscale ultrasound findings include:</p><ul>
+</ul><ul><li>trauma is another potential cause of renal vein thrombosis</li></ul><p>Complications include <a href="/articles/pulmonary-embolism">pulmonary embolism</a>, renal atrophy, and <a href="/articles/renal-papillary-necrosis">papillary necrosis</a>. <a href="/articles/bland-thrombus">Bland thrombus</a> can coexist with <a href="/articles/tumour-thrombus">tumour thrombus</a>.</p><h4>Radiographic features</h4><h5>Ultrasound</h5><p>Grayscale ultrasound findings include:</p><ul>

References changed:

6. Jana T, Orlander P, Molony D. A Rare Case of Renal Vein Thrombosis Due to Urinary Obstruction. Clin Nephrol. 2015;84(2):100-3. <a href="https://doi.org/10.5414/CN108413">doi:10.5414/CN108413</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/25707456">Pubmed</a>

Images Changes:

Image 2 MRI (T2) ( update )

Caption was removed:

~~Paroxysmal nocturnal haemoglobinuria~~

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