2083710 Perinatal Renal Vein Thrombosis; Review of 6 Cases

Abstract

Renal venous thrombosis (RVT) is the most common form of venous thrombosis in neonates, causing both acute and long term kidney dysfunction. We reviewed 6 cases in which two developed renal vein thrombosis antenatally and four developed it in neonatal period. The purpose of this presentation is to emphasize the typical ultrasound appearance seen in RVT. Neonatal RVT is not a condition associated with a high mortality rate, but it is associated with significant morbidity due to renal impairment. Hence it is important to diagnose it early. Out of 6 cases, 5 neonates presented for ultrasound in first week of life (2 days to 4 days). Three were preterm and two were full term neonates. One case was diagnosed antenatally to have bilateral renal vein thrombosis, IVC thrombosis, unilateral adrenal hematoma when mother was assessed at 37 weeks of pregnancy. All cases were NICU admisssions. Clinical presentation was macroscopic hematuria and thrombocytopenia in 4 neonates. Scanning was done with high frequency linear transducer (L5-12 MHz) Transfontanellar ultrasound to look for cerebral hemorrhage was done in all cases. 5 babies had unilateral RVT and one had bilateral RVT. Typical ultrasound features of renal enlargement, diffuse increase in echogenicity, echogenic medullary streaks were seen in all cases. In 4 neonates IVC and renal vein thrombosis could be seen on first ultrasound itself, in 1 neonate it was demonstrated on follow up scan after 3 days. Calcification of thrombus was visualized in two neonates. In three babies adrenal hematoma was also associated with RVT. Transfontanellar ultrasound was normal in all cases. None of the babied had cerebral hemorrhage. Ultrasound examination is non invasive, portable and can easily be performed on neonates in NICU set up. Typical features of haematuria, palpable mass, and thrombocytopenia may not be seen in all cases of RVT, Also, well defined echogenic IVC or renal vein thrombus may not be visualized at first presentation, hence it is important to understand grey scale ultrasound features to diagnose this condition for timely treatment. It is imortant to remember that though rare, RVT is also seen in fetal life.