Renal vein thrombosis

Last revised by Ammar Ashraf on 29 Jul 2023

Renal vein thrombosis (plural: renal vein thromboses) can be either from "bland" thrombus or tumor thrombus (extension of tumor into the vein). There are numerous etiologies 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.

  • trauma is another potential cause of renal vein thrombosis

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

  • persistent cortical enhancement and lack of parenchymal enhancement

  • calyceal opacification is often delayed, diminished, or absent in the affected kidney

  • changes in attenuation, either focal or diffuse, may be present due to perfusion abnormalities 3

  • stranding of the perinephric fat owing to edema and thickening of the renal fascia may occur

  • perinephric hemorrhage may occur

  • in the chronic phase of renal vein thrombosis, the affected renal vein becomes attenuated because of retraction of the clot

  • collateral vessels may appear around the kidney in chronic cases

Renal vein thrombus may be shown on T1-weighted spin echo pulse sequences when the signal void of flowing blood in the renal vein is replaced by high signal because of thrombus.

Gradient echo technique shows thrombus as a filling defect of intermediate signal intensity that replaces the high signal of flowing blood.

Coronal MRI helps determine the extent of vena caval involvement.

MRI in patients with acute renal vein thrombosis may also show loss of corticomedullary differentiation on T1-weighted spin echo images, increased signal in the affected kidney on T2-weighted images, renal fascial thickening, and renal enlargement.

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

  • treatment of nephrotic syndrome: steroids and immune-suppression therapy

  • treatment of underlying renal cell cancer includes surgery for early-stage disease

  • anticoagulation therapy

Recognized complications of renal vein thrombosis include:

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Cases and figures

  • Case 1: renal abscess with renal vein thrombosis
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  • Case 2: renal cell carcinoma with renal vein thrombosis
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  • 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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  • Case 8: in a circumaortic left renal vein
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  • Case 9: postpartum
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  • Case 10
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  • Case 11: bilateral renal vein thrombosis
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