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.
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in children: RVT is the most common vascular condition in the neonatal kidney 1
- dehydration and sepsis are common underlying factors for renal vein thrombosis
- sickle cell disease 2
- maternal diabetes
- indwelling umbilical venous catheters
- in adults renal vein thrombosis can result from a variety of disorders, including:
- trauma is another potential cause of renal vein thrombosis
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
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.
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
Recognised complications of RVT include
- 1. Hibbert J, Howlett DC, Greenwood KL et-al. The ultrasound appearances of neonatal renal vein thrombosis. Br J Radiol. 1997;70 (839): 1191-4. Br J Radiol (abstract) - Pubmed citation
- Saborio P, Scheinman JI. Sickle cell nephropathy. J. Am. Soc. Nephrol. 1999;10 (1): 187-92. J. Am. Soc. Nephrol. (full text) - Pubmed citation
- 3. Kawashima A, Sandler CM, Ernst RD et-al. CT evaluation of renovascular disease. Radiographics. 2000;20 (5): 1321-40. Radiographics (full text) - Pubmed citation
- 4. Tempany CM, Morton RA, Marshall FF. MRI of the renal veins: assessment of nonneoplastic venous thrombosis. J Comput Assist Tomogr. 1992;16 (6): 929-34. Pubmed citation
- 5. Chauhan A, Garg N, Menias CO, Devine CE, Bhosale PR, Balachandran A. Tumor thrombus as a rare presentation of lymphoma: a case series of 14 patients. AJR Am J Roentgenol. 2015 Apr;204(4):W398-404.