Renal Vein Thrombosis Treatment & Management

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

Medical Care

  • Treatment of nephrotic syndrome: Measures may include steroids and immune-suppression therapy. Treatment of underlying renal cell cancer 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 alone, they 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. Treat hypercholesterolemia according to accepted national guidelines (ie, using appropriate low-density lipoprotein targets for primary or secondary prevention).
  • A recent study by Bianchi suggests that atorvastatin decreases the rate of progression of kidney disease, proteinuria, and hypercholesterolemia.[7]
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Surgical Care

  • Surgical treatment for renal vein thrombosis (RVT) is rarely used today.
  • Surgery has been used in the presence of bilateral renal vein thrombosis (RVT) or if pulmonary emboli have occurred and anticoagulation is contraindicated.[8] Inferior vena caval filters may be used in this instance.[9]
  • Surgery may be necessary for renal vein thrombosis (RVT) of renal cell cancer, particularly for cure of malignancy.
  • Hypernephroma or renal cell cancer is unique in that intraluminal tumor extends into the renal vein and inferior vena cava (IVC) and sometimes extends into the right atrium. In such cases, radical nephrectomy and removal of the tumor from the IVC and right atrium affords the chance of cure. This is not distant metastasis; rather, this is tumor extension within the renal vein and IVC.
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Consultations

  • Consult a nephrologist and interventional radiologist (only when medical therapy does not prevent pulmonary emboli).
  • A surgeon (urologist) can assist in the staging and potential surgery for renal cell carcinoma (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 renal cancer with extension into renal vein, IVC, and right atrium.
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Diet

  • 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 h) or in those who have chronic renal failure.[10]
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Activity

Activity is allowed as tolerated.

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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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  2. Reimold EW, Wittel RA. Renal venous thrombosis in children: changes in management. South Med J. Oct 1983;76(10):1277-84. [Medline].

  3. Dutta TK, Venugopal V. Venous thromboembolism: the intricacies. J Postgrad Med. Jan-Mar 2009;55(1):55-64. [Medline].

  4. Dauger S, Michot C, Garnier A, Hurtaud-Roux MF. [Neonatal renal venous thrombosis in 2008]. Arch Pediatr. Feb 2009;16(2):132-41. [Medline].

  5. 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].

  6. Basterrechea Iriarte F, Sota Busselo I, Nogués Pérez A. [Evolution of imaging in renal vein thrombosis in the newborn]. An Pediatr (Barc). Nov 2008;69(5):442-5. [Medline].

  7. Bianchi S, Bigazzi R, Caiazza A, et al. A controlled, prospective study of the effects of atorvastatin on proteinuria and progression of kidney disease. Am J Kidney Dis. Mar 2003;41(3):565-70. [Medline].

  8. Jaako Dardashti V, Bekassy ZD, Ljung R, Gelberg J, Wingren P, Simonsen O, et al. Successful thrombolysis of neonatal bilateral renal vein thrombosis originating in the IVC. Pediatr Nephrol. Mar 24 2009;[Medline].

  9. Janvier AL, Hamdan H, Malas M. Bilateral renal vein thrombosis and subsequent acute renal failure due to IVC filter migration and thrombosis. Clin Nephrol. May 2010;73(5):408-12. [Medline].

  10. Maroni BJ. Protein restriction in the pre-end-stage renal disease (ESRD) patient: who, when, how, and the effect on subsequent ESRD outcome. J Am Soc Nephrol. Dec 1998;9(12 Suppl):S100-6. [Medline].

  11. McCarthy E, Mahony NO, Guiney M, Ryan JM. Successful catheter directed thrombolysis of IVC and renal vein occlusive thrombus. Ir Med J. Nov-Dec 2011;104(10):311-2. [Medline].

  12. Babu SC, Manoni T, Shah PM. Malignant renal tumor with extension to the inferior vena cava. The American Journal of Surgery. 1998;176:137 -139.

  13. Borrello JA. Renal MR angiography. Magn Reson Imaging Clin N Am. Feb 1997;5(1):83-93. [Medline].

  14. Irish AB, Green FR, Gray DW, et al. The factor V Leiden (R506Q) mutation and risk of thrombosis in renal transplant recipients. Transplantation. Aug 27 1997;64(4):604-7. [Medline].

  15. Kim HS, Fine DM, Atta MG. Catheter-directed thrombectomy and thrombolysis for acute renal vein thrombosis. J Vasc Interv Radiol. May 2006;17(5):815-22. [Medline].

  16. Markowitz GS, Brignol F, Burns ER, et al. Renal vein thrombosis treated with thrombolytic therapy: case report and brief review. Am J Kidney Dis. May 1995;25(5):801-6. [Medline].

  17. Meehan SM, Limsrichamrern S, Manaligod JR, et al. Platelets and capillary injury in acute humoral rejection of renal allografts. Hum Pathol. Jun 2003;34(6):533-40. [Medline].

  18. Nickolas TL, Radhakrishnan J, Appel GB. Hyperlipidemia and thrombotic complications in patients with membranous nephropathy. Semin Nephrol. Jul 2003;23(4):406-11. [Medline].

  19. Orth SR, Ritz E. The nephrotic syndrome. N Engl J Med. Apr 23 1998;338(17):1202-11. [Medline].

  20. Zini L, Haulon S, Leroy X, et al. Endoluminal occlusion of the inferior vena cava in renal cell carcinoma with retro- or suprahepatic caval thrombus. BJU Int. Jun 2006;97(6):1216-20.

 
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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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