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Renal vein thrombosis

Dr Yuranga Weerakkody and Radswiki et al.

Renal vein thrombosis (RVT) has numerous aetiologies, but most commonly occurs in patients with nephrotic syndrome. This syndrome is responsible for a hypercoagulable state.  It is commoner on the left side, presumably to the left renal vein being considerably longer than the right.

Pathophysiology

  • in children - dehydration and sepsis are common underlying factors for renal vein thrombosis, with other predisposing factors in the neonate subgroup including; polycythaemia, maternal diabetes and indwelling umbilical venous catheters.  It is the commonest vascular condition in the neonatal kidney.1
  • in adults - renal vein thrombosis can result from a variety of disorders, including 
  • trauma is another potential cause of renal vein thrombosis.

Complications include pulmonary embolism, renal atrophy, and papillary necrosis.

Radiographic features

Ultrasound

Gray scale 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.2

MRI

MR venography may be performed, especially if the patient has renal impairment which doesnt permit the use of intravenous contrast.3 

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 with Warfarin

Complications 

Recognised complications of RVT include

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