Renal Vein Thrombosis Clinical Presentation
- Author: Igor A Laskowski, MD; Chief Editor: Vincent Lopez Rowe, MD more...
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
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).
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