Renal Vein Thrombosis Treatment & Management
- Author: Igor A Laskowski, MD; Chief Editor: Vincent Lopez Rowe, MD more...
Measures employed to treat nephrotic syndrome may include steroids and immunosuppressive therapy. Treatment of underlying renal cell carcinoma (RCC) includes surgery for early-stage disease.
Symptomatic treatment includes diuretics and angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) to decrease proteinuria from nephrotic syndrome. If a combination of ACEIs and ARBs lowers protein excretion more than either does alone, the two types of medication should be used together. Decreasing protein loss in the urine decreases hypercoagulability.
Anticoagulation with warfarin has been recommended in some studies for prophylaxis against pulmonary embolism (PE). PE from renal vein thrombosis (RVT) should be diagnosed and treated exactly as it is when it results from other sources (ie, heparin, warfarin). If RVT is associated with PE, anticoagulation must be continued as long as nephrotic syndrome is present.
The indicators for thrombolysis in the setting of RVT are unclear. No data are available comparing thrombolytic therapy with anticoagulation. In pulmonary embolic disease from other causes, thrombolytics are indicated in the setting of pulmonary hypertension (as found during examination or discovered by echocardiography). Catheter-based techniques for rapid delivery of thrombolytics in the setting of acute or refractory RVT have been described.[9, 10]
Hypercholesterolemia should be treated according to accepted national guidelines (ie, by using appropriate low-density lipoprotein targets for primary or secondary prevention).
A study by Bianchi suggested that atorvastatin decreases the rate of progression of kidney disease, proteinuria, and hypercholesterolemia.
Surgical treatment of RVT is rarely indicated today. It has been used if bilateral RVT is present or if pulmonary emboli have occurred and anticoagulation is contraindicated. Inferior vena caval filters may be used in this instance. Surgery may be necessary for RVT of RCC, particularly for cure of malignancy.
Hypernephroma or RCC is unique in that intraluminal tumor extends into the renal vein and inferior vena cava and sometimes extends into the right atrium. In such cases, radical nephrectomy and removal of the tumor from the inferior vena cava and right atrium affords the chance of cure. This is not distant metastasis; rather, it is tumor extension within the renal vein and inferior vena cava.
Consult a nephrologist and an interventional radiologist (only when medical therapy does not prevent pulmonary emboli).
A surgeon (urologist) can assist in the staging and potential surgery for RCC (early-stage disease). A combined team that consists of a urologist, vascular surgeon, cardiac surgeon, transplant surgeon, or a combination thereof works together in complex cases of RCC with extension into the renal vein, inferior vena cava, and right atrium.
Diet and Activity
Many nephrologists recommend normal protein intake for patients with nephrotic syndrome. Protein restriction may be used with benefit in patients who are nephrotic who do not spill massive amounts of protein (approximately 10 g or more over 24 hours) or in those who have chronic renal failure.
Activity is allowed as tolerated.
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