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Renal Vein Thrombosis Workup

  • Author: Igor A Laskowski, MD; Chief Editor: Vincent Lopez Rowe, MD  more...
 
Updated: Dec 08, 2014
 

Imaging Studies

In RVT, intravenous pyelography (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 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 RVT. Occasionally, it is not diagnostic, in which case selective renal vein catheterization can be performed.

Renal arteriography may be useful in situations where RVT is secondary to trauma or tumor, in which case renal artery involvement is common.

Renal ultrasonography is a safe noninvasive technique. With underlying RVT, the kidneys swell and become echogenic, with prominent echo-poor medullary pyramids. Color Doppler scanning may also provide information. However, ultrasonography usually is not sensitive enough to assist in making the diagnosis.[6]

Computed tomography (CT) currently is the procedure of choice for diagnosing RVT noninvasively (see the image below). Intravenous (IV) infusion of contrast material assists in visualizing the renal veins. CT also demonstrates the presence of renal cell cancer.

This CT scan shows renal vein thrombosis secondary This CT scan shows renal vein thrombosis secondary to renal cell cancer. The arrow is pointed at the thrombosed renal vein.

At some point, magnetic resonance imaging (MRI) may become the procedure of choice for the diagnosis of RVT (see the image below). MRI produces high-contrast images between flowing blood, vascular walls, and surrounding tissue. Its major benefit is the avoidance of radiation and IV contrast material. MRI also may help detect 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.

In a study comparing the diagnostic accuracy of three-dimensional contrast-enhanced magnetic resonance venography (3D-CE-MRV) with that of multidetector CT venography (as the reference standard) for detecting RVT, Zhang et al found that the sensitivities and specificities of 3D-CE-MRV relative to CT venography were 94.1% and 100% on a per-patient basis and 95.5% and 100% on a per-vessel basis.[7] They concluded that 3D-CE-MRV would be an optimal alternative imaging modality for detecting RVT.

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Histologic Findings

Renal biopsy plays an essential role in the evaluation of patients who are nephrotic and who have RVT. Renal histologic features of these patients reflect the responsible primary renal disease. Membranous nephropathy is the most common finding (see the image below).

This renal biopsy shows membranous nephropathy. Li This renal biopsy shows membranous nephropathy. Light (hematoxylin and eosin) stain shows thickened capillary loops via electron microscopy, with subepithelial deposits.
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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. Studies that may be helpful include the following:

  • Cholesterol levels for hypercholesterolemia
  • Albumin levels for hypoalbuminemia
  • Serum complement levels
  • Urine protein and loss renal function studies, including serum creatinine and blood urea nitrogen (BUN); these are necessary because RVT may present as unexplained acute renal failure or a sudden increase in proteinuria
  • Review of renal biopsy
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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, Society for Vascular Surgery, Americas Hepato-Pancreato-Biliary Association, Vascular and Endovascular Surgery Society, Transplantation Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Travis J Phifer, MD 

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, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Chief Editor

Vincent Lopez Rowe, MD Professor of Surgery, Program Director, Vascular Surgery Residency, Department of Surgery, Division of Vascular Surgery, Keck School of Medicine of the University of Southern California

Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, Society for Vascular Surgery, Vascular and Endovascular Surgery Society, Society for Clinical Vascular Surgery, Pacific Coast Surgical Association, Western Vascular Society

Disclosure: Nothing to disclose.

Additional Contributors

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, Societe Internationale d'Urologie (International Society of Urology), American Urological Association

Disclosure: Nothing to disclose.

Acknowledgements

Sateesh C Babu, MD Professor of Clinical Surgery, New York Medical College; Chief, Vascular and Endovascular Surgery, Westchester Medical Center

Disclosure: Nothing to disclose.

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.

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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