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