Neonatal renal venous thrombosis in Germany between 1992 and 1994: epidemiology, treatment and outcome

Abstract

Renal venous thrombosis (RVT) occurs mainly in the neonatal period and bears a dismal prognosis for individual kidney function. There is no generally accepted therapeutic regimen as controlled clinical trials are lacking. Over the last few years, thrombolytic therapy has been successfully employed by single centres. The present study set out to gather up-to-date information on the incidence, therapy and outcome of neonatal RVT as part of a prospective nation wide survey on neonatal thrombosis in Germany to serve as a basis for therapeutic trials in the future. Between 1992 and 1994 the minimum incidence of symptomatic neonatal RVT in Germany was 2.2 per 100,000 live births (95% confidence interval 1.4-3.3). Out of 35 cases, RVT occurred in 15 premature babies (incidence 13 per 100,000 live births (95% confidence interval 5.9-24.8). Ten babies had associated caval occlusion. Therapy was supportive in 8, low dose heparin was used in 14, full heparinization in 9 and thrombolytic therapy in 4 children. On follow-up after a median time of 11.5 months, renal atrophy was present in 26 out of 39 affected kidneys. Neonatal renal venous thrombosis still leads to irreversible kidney damage in the majority of cases. Because of the low incidence a multi-national multi-centre therapeutic trial over a long period has to be considered in order to determine the optimal therapeutic approach.