Renal Vein Thrombosis Workup

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

Laboratory Studies

  • No specific lab studies are indicated for renal vein thrombosis (RVT) except those specific for nephrotic syndrome or other associated factors such as trauma or coexisting hypercoagulable state.
    • Hypercholesterolemia
    • Hypoalbuminemia
    • Serum complement levels
    • Urine protein and loss renal function studies, including serum creatinine and blood urea nitrogen (BUN): These are necessary because renal vein thrombosis (RVT) may present as unexplained acute renal failure or a sudden increase in proteinuria.
    • Review of renal biopsy
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Imaging Studies

  • In renal vein thrombosis (RVT), an intravenous pyelogram (IVP) with an abdominal plain film may reveal an enlarged kidney. If the renal pelvis is observed, it is usually distorted. An infrequent but characteristic finding of renal vein thrombosis (RVT) is notching of the ureter, which occurs when collateral veins near the ureters become tortuous. IVP seldom is used to help make the diagnosis.
  • Inferior vena cavography may help provide a diagnosis of renal vein thrombosis (RVT). Occasionally, inferior vena cavography is not diagnostic, at which point selective renal vein catheterization can be performed.
  • Renal arteriography may be useful in situations in which renal vein thrombosis (RVT) is secondary to trauma or tumor, in which case renal artery involvement is common.
  • Renal ultrasound is a safe noninvasive technique. With underlying renal vein thrombosis (RVT), the kidneys swell and become echogenic, with prominent echo-poor medullary pyramids. Color Doppler scanning may also provide information. However, ultrasound is usually not sensitive enough to assist in making the diagnosis.[6]
  • CT scan currently is the procedure of choice for diagnosing renal vein thrombosis (RVT) noninvasively, as depicted in the image below. Intravenous infusion of contrast material assists in visualizing the renal veins. CT scanning also demonstrates the presence of renal cell cancer. This CT scan shows renal vein thrombosis secondaryThis CT scan shows renal vein thrombosis secondary to renal cell cancer. The arrow is pointed at the thrombosed renal vein.
  • In the future, magnetic resonance imaging (MRI) may become the procedure of choice for the diagnosis of RVT, as depicted in the image below. MRI produces high-contrast images between flowing blood, vascular walls, and surrounding tissue. The major benefit is the avoidance of radiation and intravenous contrast material. MRI also may help detect renal vein thrombosis (RVT) and the presence of tumor. This MRI is from a patient with renal cell cancer 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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Procedures

Renal biopsy has an essential role in the evaluation of patients who are nephrotic and who have renal vein thrombosis (RVT).

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Histologic Findings

Renal histologic features of patients who are nephrotic and who have renal vein thrombosis (RVT) are representative of the responsible primary renal disease. Membranous nephropathy is the most common finding.

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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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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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