You are here: Urology Textbook > Kidneys > Renal vein thrombosis

Renal Vein Thrombosis: Symptoms, Diagnosis and Treatment

Definition

Renal vein thrombosis is a partial or complete thrombotic occlusion of a renal vein that may lead to loss of renal function.

Epidemiology

Renal vein thrombosis is rare, with peak incidence in infants and adults. In most cases, precipitating risk factors are present (see below).

Etiology of Renal Vein Thrombosis

The causes and pathophysiology of renal vein thrombosis are similar to those of deep vein thrombosis (Virchow’s triad). A combination of causes is often present, as in pediatric high-risk patients: dehydration, perinatal asphyxia, sepsis, hypotension, and cyanotic heart disease. The risk of pulmonary embolism is substantially increased.

• Endothelial injury: Vasculitis, trauma, renal transplantation, or tumor infiltration
• Venous outflow obstruction: Perinatal asphyxia, hypotension, or cyanotic heart disease. Compression of the renal vein by retroperitoneal tumors or nutcracker syndrome
• Hypercoagulability: Severe dehydration, nephrotic syndrome, thrombophilia syndromes, pregnancy, or inflammatory systemic diseases

Signs and Symptoms

The clinical presentation depends on the speed and extent of venous occlusion; asymptomatic courses are possible. Otherwise, patients may present with flank pain, hematuria, nausea, fever, and, rarely, a painful palpable renal swelling. Acute deterioration of renal function, oliguria, or anuria may occur, particularly in bilateral renal vein thrombosis or in a solitary kidney.

Diagnostic Workup of Renal Vein Thrombosis

Laboratory Tests

Findings may include microscopic hematuria, proteinuria, and elevated serum creatinine. If renal vein thrombosis is suspected, further testing includes quantification of proteinuria, serum protein electrophoresis, C-reactive protein, lipid profile, and coagulation studies.

Ultrasonography

Ultrasonography helps exclude urinary tract obstruction and assess for renal enlargement. Doppler ultrasonography can detect renal vein thrombosis and possible extension of the thrombus into the inferior vena cava.

CT or MR Angiography

CT or MR angiography reliably detects renal vein thrombosis. Chest CT may be performed to assess for pulmonary embolism.

Treatment of Renal Vein Thrombosis

• Initiate therapeutic anticoagulation immediately; the duration depends on the risk profile, underlying disease, and renal function
• Treat the underlying disease, such as nephrotic syndrome or an underlying malignancy
• Consider endovascular intervention or thrombolysis in selected patients with acute renal failure (bilateral thrombosis), after renal transplantation, with persistent flank pain, or with contraindications to anticoagulation
• Reserve surgery for exceptional cases

References

M. Asghar, K. Ahmed, S. S. Shah, M. K. Siddique, P. Dasgupta, and M. S. Khan, “Renal vein thrombosis.,” Eur. J. Vasc. Endovasc. Surg., vol. 34, no. 2, pp. 217–223, 2007.

  Deutsche Version: Nierenvenenthrombose

Urology-Textbook.com – Choose the Ad-Free, Professional Resource

This website is designed for physicians and medical professionals. It presents diseases of the genital organs through detailed text and images. Some content may not be suitable for children or sensitive readers. Many illustrations are available exclusively to Steady members. Are you a physician and interested in supporting this project? Join Steady to unlock full access to all images and enjoy an ad-free experience. Try it free for 7 days—no obligation.

New release: The first edition of the Urology Textbook as an e-book—ideal for offline reading and quick reference. With over 1300 pages and hundreds of illustrations, it’s the perfect companion for residents and medical students. After your 7-day trial has ended, you will receive a download link for your exclusive e-book.