Renal vein thrombosis

Dr Derek Smith and Radswiki et al.

Renal vein thrombosis 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.

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

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
  • enlarged kidney may reach to a very large size
  • persistent cortical enhancement and lack of parenchymal enhancement
  • changes in attenuation, either focal or diffuse, may be present due to perfusion abnormalities 3
  • collateral vessels may appear around the kidney in chronic cases

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

  • 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 renal vein thrombosis include:

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Article information

rID: 12366
Synonyms or Alternate Spellings:
  • Renal vein thrombosis (RVT)

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Cases and figures

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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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    Case 4: with renal venous infarction
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    Case 5: old RVT with collateral circulation
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    Case 6
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    Case 7
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