Renal vein thrombosis
Renal vein thrombosis is a hypercoagulable complication most often seen with the nephrotic syndrome, particularly membranous nephropathy, presenting with flank pain, hematuria, and acute kidney injury, though it can be asymptomatic. Renal ultrasonography with Doppler is the preferred initial imaging test, especially when contrast should be avoided, and treatment is therapeutic anticoagulation continued for a minimum of 3 months or longer while the provoking hypoalbuminemia persists.
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What this article covers
- Overview
Renal vein thrombosis (RVT) is thrombotic occlusion of the renal vein, most often arising as a complication of the hypercoagulable state of the nephrotic syndrome.
- Epidemiology
Most commonly a complication of the nephrotic syndrome, appearing more often with membranous nephropathy than with other nephrotic pathologies.
- Risk factors
Nephrotic syndrome with hypoalbuminemia, the dominant risk factor, with risk rising as albumin falls below 2.8 g/dL and further below 2.5 g/dL.
- Pathophysiology
The nephrotic syndrome creates a hypercoagulable state through combined loss and overproduction of coagulation factors: urinary loss of antithrombin III and protein S, combined with hepatic…
- Clinical features
Flank or abdominal pain, the most common symptomatic presentation, reflecting venous congestion or infarction.
- Differential diagnosis
Acute pyelonephritis: flank pain and fever with pyuria and a positive urine culture, distinguishing infection from the sterile pyuria-free picture of RVT.
- Diagnosis
RVT is confirmed by direct visualization of thrombus in the renal vein, most reliably by selective renal venography, the gold-standard test, though less invasive imaging is used first in practice…
- Management
First, start therapeutic anticoagulation as soon as the diagnosis is confirmed (or strongly suspected with imaging pending in a high-suspicion case), the mainstay of treatment for RVT.
- Complications
Renal infarction with permanent loss of function in the affected kidney segment, particularly with acute, extensive thrombosis.
- Prognosis
Generally favorable with prompt anticoagulation, particularly when kidney function is preserved at diagnosis.
- Prevention
Recognize serum albumin under 2.8 g/dL in the nephrotic syndrome, especially with membranous nephropathy, as the threshold for elevated venous thromboembolic risk, with risk rising further below 2.5…
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