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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
 

Causes

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.

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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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Contributor Information and Disclosures
Author

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.

Acknowledgements

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.

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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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