Renal Vein Thrombosis Clinical Presentation

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

• The more common chronic form of renal vein thrombosis (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 and/or pulmonary embolism.

Observe for signs of nephrotic syndrome (edema or anasarca).

• In patients who are nephrotic, the most common underlying nephropathy associated with renal vein thrombosis (RVT) is membranous nephropathy. For a renal biopsy of membranous nephropathy, as depicted in the image below. The tumor association for renal vein thrombosis (RVT) is renal cell carcinoma. However, most cases of membranous nephropathy are idiopathic. This renal biopsy shows membranous nephropathy. Light (hematoxylin and eosin) stain shows thickened capillary loops via electron microscopy, with subepithelial deposits.
• Renal vein thrombosis (RVT) also may be the result of nephrotic syndrome from membranoproliferative glomerulonephritis, minimal change disease, rapidly progressive glomerulonephritis, amyloid, focal sclerosis, or lupus nephritis. Renal vein thrombosis (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 relationship between nephrotic syndrome and renal vein thrombosis (RVT) have evolved. Initially, nephrotic syndrome was believed to be a consequence of renal vein thrombosis (RVT). However, this presumed sequence was incorrect.

  • Experimentally induced renal vein thrombosis (RVT) causes only mild proteinuria.
  • Renal vein thrombosis (RVT) in the absence of nephrotic syndrome has been reported in the surgical literature.
  • Nephrotic patients with renal vein thrombosis (RVT) who have undergone histologic evaluation show evidence of an identifiable glomerulopathy.
  • Renal vein thrombosis (RVT) is known to occur after the onset of nephrotic syndrome. Thus, nephrotic syndrome is not a direct result of renal vein thrombosis (RVT) but rather leads to renal vein thrombosis (RVT).
• SLE has also been associated with renal vein thrombosis (RVT).

  • In general, patients with lupus and documented renal vein thrombosis (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 renal vein thrombosis (RVT) in SLE.
• Renal vein thrombosis (RVT) is an uncommon but definite problem in neonates. A possible association exists between renal vein thrombosis (RVT) and the factor V Leiden mutation in this age group.
• Other diseases or situations that have been associated with renal vein thrombosis (RVT) include antithrombin III deficiency, protein C or S deficiency, antiphospholipid antibody syndrome, pregnancy or estrogen therapy (all hypercoagulable states), renal vein invasion by malignant cells, postrenal transplantation, Behçet syndrome, and extrinsic compression (eg, lymph nodes, tumor, retroperitoneal fibrosis, aortic aneurysm). Other than renal cell cancer, the other associations are uncommon.
• Trauma, ingestion of oral contraceptive agents, dehydration (infants), and steroid administration also have been associated with renal vein thrombosis (RVT).