Renal vein thrombosis

Dr Henry Knipe and Radswiki et al.

Renal vein thrombosis (RVT) can be either from "bland" thrombus or tumour thrombus (extension of tumor into the vein). There are numerous aetiologies for bland thrombus, but it most commonly occurs in the hypercoagulable nephrotic syndrome. Renal vein thrombus is commoner on the left side, presumably due to the left renal vein being considerably longer than the right.

Pathology

Complications include pulmonary embolism, renal atrophy, and papillary necrosis. Bland thrombus can coexist with tumour thrombus.

Radiographic features

Ultrasound

Grayscale ultrasound findings include

  • renal enlargement with hypoechoic cortex from edema (early phase)
  • decreasing size and increased echogenicity (late)
  • Doppler findings include reversal of arterial diastolic flow, absent venous flow, visualization of thrombus within the lumen, high resistance in the renal artery with elevated resistive index
 CT

As with venous thrombosis elsewhere, the thrombosis is observed as a filling defect during venous phase imaging following intravenous contrast. Changes in the attenuation, either focal or diffuse, may be present in the end organ kidney due to perfusion abnormalities 3

MRI

MR venography may be performed, especially if the patient has renal impairment which does not permit the use of intravenous contrast 4 

Treatment and prognosis

  • treatment of nephrotic syndrome: steroids and immune-suppression therapy
  • treatment of underlying renal cell cancer includes surgery for early-stage disease
  • anticoagulation therapy
Complications

Recognised complications of RVT include

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Article Information

rID: 12366
Systems: Vascular, Urogenital
Synonyms or Alternate Spellings:
  • Renal vein thrombosis (RVT)
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    Case 1: renal abscess with RVT
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    Case 2: renal cell carcinoma with renal vein thrombosis
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    Markedly swollen,...
    Case 3
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    CECT image of the...
    Case 4: with renal venous infarction
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    Case 5: old RVT with collateral circulation
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