Renal Vein Thrombosis Follow-up

  • Author: Igor A Laskowski, MD; Chief Editor: Vincent Lopez Rowe, MD   more...
 
Updated: Apr 16, 2012
 

Further Inpatient Care

Further inpatient care is as needed for loss of renal function or for the treatment of pulmonary emboli.

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Further Outpatient Care

Further outpatient care is as needed for loss of renal function or for the treatment of pulmonary emboli.

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Inpatient & Outpatient Medications

  • For nephrotic syndrome, see the Medical Care section. The primary abnormality in nephrotic syndrome is excessive urinary protein loss. Urinary protein is injurious to the renal tubules.
  • For pulmonary emboli, see the Medical Care section.
  • 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
  • Cyclosporine has demonstrated benefit in early trials for treatment of membranous nephropathy. A cure of the underlying nephropathy reverses nephrotic syndrome and renal vein thrombosis (RVT).
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Transfer

For thrombolytics 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 has to be placed above the level of renal veins (suprarenal IVC filter). This is unique because, in all other forms of DVT and pulmonary embolism, IVC filters are placed in the infrarenal segment of the IVC. Either the interventional radiologist or the vascular surgeon can perform this.

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Complications

  • Recurrent thromboembolic phenomena
  • Renal failure
  • Metastasis from renal cell cancer
  • Problems specific to etiologic cause (eg, graft failure after renal transplantation)
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Prognosis

  • Prognosis of any glomerular disease may be worsened by superimposition of acute renal vein thrombosis (RVT), but whether the slow development of chronic renal vein thrombosis (RVT) accelerates renal functional loss is uncertain.
  • The negative prognosis of renal vein thrombosis (RVT) is related to pulmonary embolic events. If renal vein thrombosis (RVT) is secondary to cancer, it may signal dissemination of the malignancy.
  • Graft survival after transplantation is adversely affected by renal vein thrombosis (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, American Hepato-Pancreato-Biliary Association, Peripheral Vascular Surgery Society, Society for Vascular Surgery, and Transplantation Society

Disclosure: Nothing to disclose.

Coauthor(s)

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.

Specialty Editor Board

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, American Urological Association, and Société Internationale d'Urologie (International Society of Urology)

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

Travis J Phifer, MD  Chief, Division of Vascular Surgery, Professor, Department of Surgery and Radiology, Louisiana State University Health Sciences Center in Shreveport

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, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Rebecca J Schmidt, DO, FACP, FASN  Professor of Medicine, Section Chief, Department of Medicine, Section of Nephrology, West Virginia University School of Medicine

Rebecca J Schmidt, DO, FACP, FASN is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Nephrology, International Society of Nephrology, National Kidney Foundation, Renal Physicians Association, and West Virginia State Medical Association

Disclosure: Renal Ventures Ownership interest Other

Chief Editor

Vincent Lopez Rowe, MD  Associate Professor of Surgery, Department of Surgery, Division of Vascular Surgery, University of Southern California Medical Center Program Director, Vascular Surgery Residency

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

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Sateesh C Babu, MD, to the development and writing of this article.

References

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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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