Background
Although renal vein thrombosis (RVT) has numerous etiologies, it occurs most commonly in patients with nephrotic syndrome (ie, >3 g/d protein loss in the urine, hypoalbuminemia, hypercholesterolemia, edema).
The syndrome is responsible for a hypercoagulable state. The excessive urinary protein loss is associated with decreased antithrombin III, a relative excess of fibrinogen, and changes in other clotting factors; all lead to a propensity to clot. Numerous studies have demonstrated a direct relationship between nephrotic syndrome and both arterial and venous thromboses. Why the renal vein is susceptible to thrombosis is unclear.
The renal vein may also contain thrombus after invasion by renal cell cancer. Other less common causes include renal transplantation, Behçet syndrome, hypercoagulable states, and antiphospholipid antibody syndrome.
A renal biopsy image is shown below.
This renal biopsy shows membranous nephropathy. Light (hematoxylin and eosin) stain shows thickened capillary loops via electron microscopy, with subepithelial deposits. Pathophysiology
Hypercoagulability is the etiology for both arterial and venous thromboses. In the setting of malignant invasion of the vein by cancer, the presence of the tumor cells elicits thrombosis of the renal vein only. It may also occur as the result of blunt trauma to the abdomen or back. In infants, renal vein thrombosis can be associated with dehydration.[1, 2, 3]
Epidemiology
Frequency
United States
Prevalence of renal vein thrombosis (RVT) has been difficult to establish. Studies have shown a high degree of variability in the presence of renal vein thrombosis (RVT) among patients with nephrotic syndrome, with reported rates of 5-62%.
Mortality/Morbidity
The morbidity and mortality of renal vein thrombosis (RVT) is usually secondary to the effects of nephrotic syndrome (including arterial thrombosis), renal dysfunction and/or failure, or the complications resulting from thromboembolism. If the etiology of the renal vein thrombosis (RVT) is malignancy, morbidity and mortality are a result of either thromboembolism or the cancer itself. In the setting of transplantation, renal vein thrombosis (RVT) may lead to loss of the graft. If the renal vein thrombosis (RVT) eventuates from the other causes discussed, thromboembolism is the source of complications.
Race
No race predilection exists.
Sex
No specific numbers are available. However, theoretically, membranous nephropathy, the most commonly disease associated with renal vein thrombosis (RVT), has a male-to-female ratio of 2:1. Therefore, a male preponderance may exist.
Age
Age is a factor in renal vein thrombosis (RVT) only as associated with any age-related risk of glomerular disease. For example, membranous nephropathy, the lesion most associated with renal vein thrombosis (RVT), is the most common cause of nephrotic syndrome in adults, but it is rare in children. Membranous nephropathy peaks in the fourth through sixth decade, thus making renal vein thrombosis (RVT) more likely in this specific age group. However, exact incidence or prevalence is not available.
Renal vein thrombosis (RVT) from renal cell carcinoma occurs in older age groups.
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