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Renal Vein Thrombosis Clinical Presentation

  • Author: Igor A Laskowski, MD; Chief Editor: Vincent Lopez Rowe, MD  more...
Updated: Dec 08, 2014


In patients who are nephrotic, the most common underlying nephropathy associated with RVT is membranous nephropathy. The tumor association for RVT is renal cell carcinoma (RCC). However, most cases of membranous nephropathy are idiopathic.

RVT also may be the result of nephrotic syndrome from membranoproliferative glomerulonephritis, minimal change disease, rapidly progressive glomerulonephritis, amyloid, focal sclerosis, or lupus nephritis. RVT is more common in patients with primary rather than secondary nephropathy.

Findings relative to the causative disease may be present (eg, systemic lupus erythematosus [SLE]/antiphospholipid antibody syndrome, cancer).

Theories for the putative relation between nephrotic syndrome and RVT have evolved. Initially, nephrotic syndrome was believed to be a consequence of RVT. However, this presumed sequence was found to be incorrect, for reasons including the following:

  • Experimentally induced RVT causes only mild proteinuria
  • RVT in the absence of nephrotic syndrome has been reported in the surgical literature
  • Nephrotic patients with RVT who have undergone histologic evaluation show evidence of an identifiable glomerulopathy
  • RVT is known to occur after the onset of nephrotic syndrome; thus, nephrotic syndrome is not a direct result of RVT but, rather, leads to RVT

SLE has also been associated with RVT. In general, patients with lupus and documented RVT have membranous lupus nephritis (World Heath Organization class V). Generally, thrombophlebitis and circulating anticoagulants (anticardiolipin antibodies) are believed to be much less important than nephrotic syndrome as predisposing factors of RVT in SLE.

RVT is an uncommon but definite problem in neonates. A possible association exists between RVT and the factor V Leiden mutation in this age group.

Other diseases or situations that have been associated with RVT include the following:

  • Antithrombin III deficiency
  • Protein C or S deficiency
  • Antiphospholipid antibody syndrome
  • Pregnancy or estrogen therapy
  • Renal vein invasion by malignant cells
  • Post renal transplantation
  • Behçet syndrome
  • Extrinsic compression (eg, lymph nodes, tumor, retroperitoneal fibrosis, aortic aneurysm)

Aside from RCC, the other associations are uncommon. Trauma, ingestion of oral contraceptive agents, dehydration (infants), and steroid administration also have been associated with RVT.


History and Physical Examination

The presentation of renal vein thrombosis (RVT) is variable, and patients may be asymptomatic. When RVT occurs as a result of malignancy, the signs of the renal malignancy (eg, hematuria, weight loss) predominate.

The more common chronic form of RVT is generally covert. The less frequent acute form usually occurs in younger patients, with flank pain and macroscopic hematuria, which can be severe in the acute onset of thrombosis. Patients may present with thrombosis, pulmonary embolism, or both.

The patient should be observed for signs of nephrotic syndrome (edema or anasarca).

Contributor Information and Disclosures

Igor A Laskowski, MD Assistant Professor of Surgery, Section of Vascular Surgery, New York Medical College, Westchester Medical Center

Igor A Laskowski, MD is a member of the following medical societies: American College of Surgeons, Society for Vascular Surgery, Americas Hepato-Pancreato-Biliary Association, Vascular and Endovascular Surgery Society, Transplantation Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Travis J Phifer, MD 

Travis J Phifer, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Surgeons, American Medical Association, Association for Academic Surgery, Society for Academic Emergency Medicine, Society for Vascular Surgery, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Chief Editor

Vincent Lopez Rowe, MD Professor of Surgery, Program Director, Vascular Surgery Residency, Department of Surgery, Division of Vascular Surgery, Keck School of Medicine of the University of Southern California

Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, Society for Vascular Surgery, Vascular and Endovascular Surgery Society, Society for Clinical Vascular Surgery, Pacific Coast Surgical Association, Western Vascular Society

Disclosure: Nothing to disclose.

Additional Contributors

Richard A Santucci, MD, FACS Specialist-in-Chief, Department of Urology, Detroit Medical Center; Chief of Urology, Detroit Receiving Hospital; Director, The Center for Urologic Reconstruction; Clinical Professor of Urology, Michigan State University College of Medicine

Richard A Santucci, MD, FACS is a member of the following medical societies: American College of Surgeons, Societe Internationale d'Urologie (International Society of Urology), American Urological Association

Disclosure: Nothing to disclose.


Sateesh C Babu, MD Professor of Clinical Surgery, New York Medical College; Chief, Vascular and Endovascular Surgery, Westchester Medical Center

Disclosure: Nothing to disclose.

Louis Schwing, MD Consulting Staff, Department of Internal Medicine, Carle Clinic Associates

Louis Schwing, MD is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

  1. Harris SL, Smith MP, Laurie A, Darlow BA. Neonatal renal vein thrombosis and prothrombotic risk. Acta Paediatr. 2010 Jul. 99(7):1104-7. [Medline].

  2. Reimold EW, Wittel RA. Renal venous thrombosis in children: changes in management. South Med J. 1983 Oct. 76(10):1277-84. [Medline].

  3. Dutta TK, Venugopal V. Venous thromboembolism: the intricacies. J Postgrad Med. 2009 Jan-Mar. 55(1):55-64. [Medline].

  4. Dauger S, Michot C, Garnier A, Hurtaud-Roux MF. [Neonatal renal venous thrombosis in 2008]. Arch Pediatr. 2009 Feb. 16(2):132-41. [Medline].

  5. Decoster T, Schwagten V, Hendriks J, Beaucourt L. Renal colic as the first symptom of acute renal vein thrombosis, resulting in the diagnosis of nephrotic syndrome. Eur J Emerg Med. 2009 Apr 20. [Medline].

  6. Basterrechea Iriarte F, Sota Busselo I, Nogués Pérez A. [Evolution of imaging in renal vein thrombosis in the newborn]. An Pediatr (Barc). 2008 Nov. 69(5):442-5. [Medline].

  7. Zhang LJ, Wu X, Yang GF, Tang CX, Luo S, Zhou CS, et al. Three-dimensional contrast-enhanced magnetic resonance venography for detection of renal vein thrombosis: comparison with multidetector CT venography. Acta Radiol. 2013 Dec. 54(10):1125-31. [Medline].

  8. McCarthy E, Mahony NO, Guiney M, Ryan JM. Successful catheter directed thrombolysis of IVC and renal vein occlusive thrombus. Ir Med J. 2011 Nov-Dec. 104(10):311-2. [Medline].

  9. Srinivas BC, Singh B, Srinivasa S, Reddy SS, Mahadevappa NC, Reddy B. Transcatheter pharmacomechanical approach for acute renal vein thrombosis: a rational technique. Cardiovasc Interv Ther. 2014 Jul. 29(3):275-8. [Medline].

  10. Heafner TA, Scott D, Watson JD, Propper B, Johnson C, Arthurs ZM. Combined arteriovenous thrombolytic infusion for refractory renal vein thrombosis. Ann Vasc Surg. 2014 Aug. 28(6):1564.e5-8. [Medline].

  11. Bianchi S, Bigazzi R, Caiazza A, et al. A controlled, prospective study of the effects of atorvastatin on proteinuria and progression of kidney disease. Am J Kidney Dis. 2003 Mar. 41(3):565-70. [Medline].

  12. Jaako Dardashti V, Bekassy ZD, Ljung R, Gelberg J, Wingren P, Simonsen O, et al. Successful thrombolysis of neonatal bilateral renal vein thrombosis originating in the IVC. Pediatr Nephrol. 2009 Mar 24. [Medline].

  13. Janvier AL, Hamdan H, Malas M. Bilateral renal vein thrombosis and subsequent acute renal failure due to IVC filter migration and thrombosis. Clin Nephrol. 2010 May. 73(5):408-12. [Medline].

  14. Maroni BJ. Protein restriction in the pre-end-stage renal disease (ESRD) patient: who, when, how, and the effect on subsequent ESRD outcome. J Am Soc Nephrol. 1998 Dec. 9(12 Suppl):S100-6. [Medline].

  15. Babu SC, Manoni T, Shah PM. Malignant renal tumor with extension to the inferior vena cava. The American Journal of Surgery. 1998. 176:137 -139.

  16. Borrello JA. Renal MR angiography. Magn Reson Imaging Clin N Am. 1997 Feb. 5(1):83-93. [Medline].

  17. Irish AB, Green FR, Gray DW, et al. The factor V Leiden (R506Q) mutation and risk of thrombosis in renal transplant recipients. Transplantation. 1997 Aug 27. 64(4):604-7. [Medline].

  18. Kim HS, Fine DM, Atta MG. Catheter-directed thrombectomy and thrombolysis for acute renal vein thrombosis. J Vasc Interv Radiol. 2006 May. 17(5):815-22. [Medline].

  19. Markowitz GS, Brignol F, Burns ER, et al. Renal vein thrombosis treated with thrombolytic therapy: case report and brief review. Am J Kidney Dis. 1995 May. 25(5):801-6. [Medline].

  20. Meehan SM, Limsrichamrern S, Manaligod JR, et al. Platelets and capillary injury in acute humoral rejection of renal allografts. Hum Pathol. 2003 Jun. 34(6):533-40. [Medline].

  21. Nickolas TL, Radhakrishnan J, Appel GB. Hyperlipidemia and thrombotic complications in patients with membranous nephropathy. Semin Nephrol. 2003 Jul. 23(4):406-11. [Medline].

  22. Orth SR, Ritz E. The nephrotic syndrome. N Engl J Med. 1998 Apr 23. 338(17):1202-11. [Medline].

  23. Zini L, Haulon S, Leroy X, et al. Endoluminal occlusion of the inferior vena cava in renal cell carcinoma with retro- or suprahepatic caval thrombus. BJU Int. 2006 Jun. 97(6):1216-20.

This renal biopsy shows membranous nephropathy. Light (hematoxylin and eosin) stain shows thickened capillary loops via electron microscopy, with subepithelial deposits.
This CT scan shows renal vein thrombosis secondary to renal cell cancer. The arrow is pointed at the thrombosed renal vein.
This MRI is from a patient with renal cell cancer and renal vein thrombosis. The arrow is on the thrombosed vein.
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