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renal vein thrombosis

Etiology: (risk factors): 1) trauma 2) extrinsic compression a) lymph nodes b) tumor c) aortic aneurysm 3) hypercoagulable states a) nephrotic syndrome -> membranous glomerulonephritis b) invasion by renal cell carcinoma c) dehydration in infants d) pregnancy e) oral contraceptives f) anti-phospholipid antibody syndrome [3] Clinical manifestations: 1) acute cases generally occur in children (case of 50 yo woman) [3] a) sudden loss in renal function b) fever/chills c) lumbar tenderness (with renal enlargement) d) leukocytosis e) hematuria f) flank pain [4] 2) subacute renal deterioration a) in setting of risk factors(s) (see etiology) b) exacerbation of nephrotic syndrome c) hematuria 3) indolent cases may occur in elderly a) pulmonary emboli b) hypertension 4) other a) Fanconi syndrome b) proximal renal tubular acidosis c) palpable abdominal mass(es) not a feature [3] Laboratory: - elevated serum lactate dehydrogenase - elevated serum creatinine - CBC: leukocytosis - urinalysis: hematuria, leukocytouria, proteinuria (albuminuria) Radiology: 1) renal ultrasound 2) magnetic resonance 3) selective renal venography 4) CT angiography (initial diagnostic test) [3] Complications: 1) systemic thromboembolism 2) hemorrhagic infarction 3) rupture of kidney 4) 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: 1) anticoagulation to prevent pulmonary emboli 2) streptokinase 3) nephrectomy in infants with renal infarction 4) thrombectomy

General

splanchnic vein thrombosis (SVT) renal vascular disease

References

  1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 269
  2. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 1559
  3. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015 - Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025
  4. NEJM Knowledge+
  5. Casey D, Romero K, Patel R, et al. Bilateral renal vein thrombosis in membranous nephropathy: hypoalbuminemia predictive of venous thromboembolism in nephrotic syndrome. Cureus. 2022;14:e30032. PMID: 36348912