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Renal Vein Thrombosis Follow-up

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

Transfer

For thrombolytic therapy or interventional radiology, transfer patients, especially if a vena caval filter is necessary in the event of failure of medical therapy for recurrent thromboembolism. The vena cava filter in these cases must be placed above the level of the renal veins (ie, suprarenally). This requirement is unique because in all other forms of deep vein thrombosis (DVT) and PE, the filters are placed in the infrarenal segment of the inferior vena cava. Either the interventional radiologist or the vascular surgeon can place the filter.

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Complications

Potential complications include the following:

  • Recurrent thromboembolic phenomena
  • Renal failure
  • Metastasis from RCC
  • Problems specific to a particular cause (eg, graft failure after renal transplantation)
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Prognosis

The prognosis of any glomerular disease may be worsened by superimposition of acute RVT, but it is unclear whether the slow development of chronic RVT accelerates renal functional loss. The negative prognosis of RVT is related to pulmonary embolic events. If RVT is secondary to cancer, it may signal dissemination of the malignancy. Graft survival after transplantation is adversely affected by RVT.

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Further Inpatient and Outpatient Care

Further inpatient and outpatient care is as needed for loss of renal function or for the treatment of PE. For nephrotic syndrome, see Medical Care. The primary abnormality in nephrotic syndrome is excessive urinary protein loss. Urinary protein is injurious to the renal tubules. For PE, see Medical Care.

ACEIs and ARBs decrease urine protein through an effect on efferent arteriolar pressure. Titrate to as high a dose as tolerated. If protein loss decreases, hypercoagulability improves. Atorvastatin may be helpful. Cyclosporine has demonstrated benefit in early trials for treatment of membranous nephropathy. Cure of the underlying nephropathy reverses nephrotic syndrome and RVT.

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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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