eMedicine Specialties > Vascular Surgery > Medical Topics

Renal Vein Thrombosis: Follow-up

Author: Igor A Laskowski, MD, Assistant Professor of Surgery, Section of Vascular Surgery, New York Medical College, Westchester Medical Center
Coauthor(s): Louis Schwing, MD, Consulting Staff, Department of Internal Medicine, Carle Clinic Associates
Contributor Information and Disclosures

Updated: Sep 17, 2009

Follow-up

Further Inpatient Care

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

Further Outpatient Care

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

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).

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.

Complications

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

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).

Miscellaneous

Medicolegal Pitfalls

  • Missing renal vein thrombosis (RVT) as the source for pulmonary emboli is a medical/legal pitfall.
  • When a patient presents with pulmonary embolism (PE) and no evidence of lower extremity deep vein thrombosis (DVT), the patient should be examined for renal vein thrombosis and renal cancer. Renal cell cancer (hypernephroma) is unique in that it may cause PE by 2 mechanisms. The first is an increased secretion of erythropoietin, which increases blood viscosity and hypercoagulability, causing DVT and PE. The other mechanism is tumor extension into the renal vein and IVC (tumor thrombus), which may break loose and cause PE.
  • Avoid use of warfarin (Coumadin) for renal vein thrombosis (RVT) during pregnancy. Heparin should be used instead.
 
Acknowledgments

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.



More on Renal Vein Thrombosis

Overview: Renal Vein Thrombosis
Differential Diagnoses & Workup: Renal Vein Thrombosis
Treatment & Medication: Renal Vein Thrombosis
Follow-up: Renal Vein Thrombosis
Multimedia: Renal Vein Thrombosis
References
Further Reading
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References

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  4. Decoster T, Schwagten V, Hendriks J, Beaucourt L. Renal colic as the first symptom of acute renal vein thrombosis, resulting in the diagnosis of nephrotic syndrome. Eur J Emerg Med. Apr 20 2009;[Medline].

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Further Reading

Clinical guidelines

Venous thromboembolism.
Institute for Clinical Systems Improvement - Private Nonprofit Organization.  1998 Jun (revised 2007 Jun).  91 pages.  [NGC Update Pending] NGC:005885

Antithrombotic therapy supplement.
Institute for Clinical Systems Improvement - Private Nonprofit Organization.  2001 Sep (revised 2007 Aug).  64 pages.  NGC:005971

Prevention of venous thromboembolism. American College of Chest Physicians evidence-based clinical practice guidelines (8th edition).
American College of Chest Physicians - Medical Specialty Society.  2001 Jan (revised 2008 Jun).  73 pages.  NGC:006665

Clinical trials

Use of Low Molecular Weight Heparin (Tinzaparin) to Treat Blood Clots in Patients With Kidney Failure

Impact of Providing High Protein Bar to Dialysis Patients With Low Serum Albumin

CNI-Free de Novo Protocol in Patients Undergoing Liver Transplantation With Renal Impairment

Related eMedicine topics

 Renal Vein Thrombosis  (Radiology)

Chronic Renal Failure

Pulmonary Embolism

Renal Cell Carcinoma

Inferior Vena Caval Thrombosis

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Keywords

renal vein thrombosis, thrombosis, renal vein, RVT, nephrotic syndrome, hypercoagulable state, renal vein, clotting, clot, hypoalbuminemia, hypercholesterolemia, arterial thrombosis, renal dysfunction, renal failure, thromboembolism

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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.

Medical Editor

Richard A Santucci, MD, FACS, Chief of Urology, Detroit Receiving Hospital; Specialist-in-Chief of Urology, Detroit Medical Center; Chief of Urologic Trauma Surgery, Sinai Grace Hospital; Director, The Center for Urologic Reconstruction; Clinical Professor of Urology, Michigan State 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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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.

CME Editor

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 Osteopathic Internists, 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: Abbott Grant/research funds Speaking and teaching; Genzyme Honoraria Consulting; Amgen Honoraria Speaking and teaching; Ortho Biotech Honoraria Speaking and teaching

Chief Editor

William H Pearce, MD, Chief, Division of Vascular Surgery, Violet and Charles Baldwin Professor of Vascular Surgery, Department of Surgery, Northwestern University School of Medicine
William H Pearce, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, American Surgical Association, Association for Academic Surgery, Association of VA Surgeons, Central Surgical Association, New York Academy of Sciences, Society for Vascular Surgery, Society of Critical Care Medicine, Society of University Surgeons, and Western Surgical Association
Disclosure: Nothing to disclose.

 
 
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