Renal vein thrombosis (RVT), an uncommon disorder, is a blood clot in one or both of the veins that carries blood from the kidneys back to the heart. In infants, the condition may occur suddenly and result in kidney failure and severe acute illness. In adults, the condition may produce no symptoms. In many cases, blood clots may also lodge in a pulmonary artery, where the clot, known as an embolism, may produce chest pain and shortness of breath.
WHAT CAUSES RENAL VEIN THROMBOSIS?
- In adults, renal vein thrombosis is almost always a result of nephrotic syndrome, although there are other causes.
- In children, renal vein thrombosis may occur following sepsis and dehydration.
- Trauma is another contributor to renal vein thrombosis.
- Diarrhea with severe dehydration is the most common cause in children.
- An injury to the abdomen or lower back may result in RVT.
- Malignant kidney tumors that extend into the renal vein can lead to RVT.
- Pregnancy or the use of oral contraceptives increases the risk.
SYMPTOMS OF RENAL VEIN THROMBOSIS
- In adults, there are often no symptoms as the clot develops slowly.
- Pain, usually mild, in the lower back and side. There may be visible blood in the urine.
- In infants: fever and chills; blood in the urine
- Chest pain, shortness of breath, cough, possibly with bloody sputum, profuse perspiration, anxiety, and palpitations, due to pulmonary emboli
- Preventive use of anticoagulant drugs (such as warfarin) may be recommended in high-risk individuals who have massive amounts of protein in the urine.
- Maintain body fluids to prevent dehydration.
- Patient history and physical examination
- Urine sample
- Renal venography (injection of a contrast material into the renal vein prior to x-rays), ultrasound scans, or MRI (magnetic resonance imaging) may be performed to locate a blood clot.
- Gray scale ultrasound may be performed to detect renal enlargement.
- Urinalysis shows hematuria, proteinuria, oliguria and casts.
- Blood studies reveal hypoalbuminemia, leukocytosis, thrombocytopenia and hyperlipidemia.
HOW TO TREAT RENAL VEIN THROMBOSIS
- Streptokinase or urokinase (enzymes) may be administered to dissolve blood clots in severe cases of renal vein thrombosis of both renal veins associated with acute kidney failure.
- Anticoagulant medications may be prescribed on a long-term basis to reduce the risk of pulmonary and renal vein clots.
- Steroids and immune-suppression therapy can treat nephrotic syndrome.
- In infants with life-threatening cases, surgical removal of the affected kidney may be required.
WHEN TO CALL A DOCTOR
- Call a doctor if you develop nagging, persistent pain in the lower back or side, or if you have nephrotic syndrome and experience shortness of breath and chest pain.
Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference
Simeon Margolis, M.D., Ph.D., Medical Editor
Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50
Updated by Remedy Health Media