Renal vein thrombosis

Changed by Marcin Czarniecki, 2 Jan 2016

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~~ most commonly occurs in the hypercoagulablenephrotic syndrome. Renal vein thrombus is commoner on the left side, presumably due to the left renal vein being considerably longer than the right.

Pathophysiology

in children (it is the commonest vascular condition in the neonatal kidney.¹)
- dehydration and sepsis are common underlying factors for renal vein thrombosis
- sickle cell disease²
- 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
  - lymphoma⁴⁵
  - 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. Changes in the attenuation, either focal or diffuse, may be present in the end organ kidney due to perfusion abnormalities²³.

MRI

MR venography may be performed, especially if the patient has renal impairment which does not permit the use of intravenous contrast ³⁴.

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 with coumadin/Warfarin

Complications

Recognised complications of RVT include

-<p><strong>Renal vein thrombosis (RVT)</strong> 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 <a href="/articles/nephrotic-syndrome">nephrotic syndrome</a>. Renal vein thrombus is commoner on the left side, presumably due to the left renal vein being considerably longer than the right.</p><h4>Pathophysiology</h4><ul>
+<p><strong>Renal vein thrombosis (RVT)</strong> 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 <a href="/articles/nephrotic-syndrome">nephrotic syndrome</a>. Renal vein thrombus is commoner on the left side, presumably due to the left renal vein being considerably longer than the right.</p><h4>Pathophysiology</h4><ul>
+<li>
+<a href="/articles/sickle-cell-disease">sickle cell disease</a><sup>2</sup>
+</li>
+<li><a href="/articles/systemic-lupus-erythematosus">systemic lupus erythematosus</a></li>
+<li><a href="/articles/amyloidosis">amyloidosis</a></li>
~~-<li>lymphoma <sup>4</sup>~~
+<li>lymphoma<sup>5</sup>
-</ul><h5><strong> CT</strong></h5><p>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 <sup><span style="font-size:10.8333px; line-height:17.3333px">2</span></sup><span style="line-height:1.6">. </span></p><h5>MRI</h5><p>MR venography may be performed, especially if the patient has renal impairment which does not permit the use of intravenous contrast <sup>3</sup>. <sup> </sup></p><h4>Treatment and prognosis</h4><ul>
+</ul><h5><strong> CT</strong></h5><p>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 <span style="font-size:10.8333px; line-height:17.3333px"><sup>3</sup></span>. </p><h5>MRI</h5><p>MR venography may be performed, especially if the patient has renal impairment which does not permit the use of intravenous contrast <sup><span style="font-size:10.8333px; line-height:17.3333px">4</span></sup>. <sup> </sup></p><h4>Treatment and prognosis</h4><ul>

References changed:

2. Kawashima A, Sandler C, Ernst R, Tamm E, Goldman S, Fishman E. CT Evaluation of Renovascular Disease. Radiographics. 2000;20(5):1321-40. <a href="https://doi.org/10.1148/radiographics.20.5.g00se141321">doi:10.1148/radiographics.20.5.g00se141321</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/10992021">Pubmed</a>
4. Chauhan A, Garg N, Menias C, Devine C, Bhosale P, Balachandran A. Tumor Thrombus as a Rare Presentation of Lymphoma: A Case Series of 14 Patients. AJR Am J Roentgenol. 2015;204(4):W398-404. <a href="https://doi.org/10.2214/AJR.14.12782">doi:10.2214/AJR.14.12782</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/25794089">Pubmed</a>
3. Tempany C, Morton R, Marshall F. MRI of the Renal Veins. J Comput Assist Tomogr. 1992;16(6):929-34. <a href="https://doi.org/10.1097/00004728-199211000-00019">doi:10.1097/00004728-199211000-00019</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/1430444">Pubmed</a>
5. Saborio P & Scheinman J. Sickle Cell Nephropathy. J Am Soc Nephrol. 1999;10(1):187-92. <a href="https://doi.org/10.1681/ASN.V101187">doi:10.1681/ASN.V101187</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/9890326">Pubmed</a>
5. Saborio P & Scheinman J. Sickle Cell Nephropathy. J Am Soc Nephrol. 1999;10(1):187-92. <a href="https://doi.org/10.1681/ASN.V101187">doi:10.1681/ASN.V101187</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/9890326">Pubmed</a>
3. Tempany CM, Morton RA, Marshall FF. MRI of the renal veins: assessment of nonneoplastic venous thrombosis. J Comput Assist Tomogr. 1992;16 (6): 929-34. <a href="http://www.ncbi.nlm.nih.gov/pubmed/1430444">Pubmed citation</a><span class="ref_v3"></span>
4. Chauhan A, Garg N, Menias CO, Devine CE, Bhosale PR, Balachandran A. Tumor thrombus as a rare presentation of lymphoma: a case series of 14 patients. AJR Am J Roentgenol. 2015 Apr;204(4):W398-404.
2. Kawashima A, Sandler CM, Ernst RD et-al. CT evaluation of renovascular disease. Radiographics. 2000;20 (5): 1321-40. <a href="http://radiographics.rsna.org/content/20/5/1321.full">Radiographics (full text)</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/10992021">Pubmed citation</a><span class="ref_v3"></span>
2. http://jasn.asnjournals.org/content/10/1/187.full.pdf

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"}