Successful surgical thrombectomy for neonatal IVC and bilateral renal vein thrombosis

Abstract

We propose that renal salvage is possible in neonatal inferior vena cava (IVC) and bilateral renal vein thrombosis utilizing early surgical intervention. Management of bilateral renal vein thrombosis with renal impairment typically includes anti-coagulation and thrombolytic therapy. We report a case of a five day-old premature female, found to have bilateral renal vein thrombosis that had propagated up the IVC, associated with anuric renal failure. Peak BUN/creatinine was 52/4 at day of life 5, with a peak of 90/7.4 at day of life 10. After a failed attempt at intravenous thrombolytic therapy, thrombectomy was performed for the IVC as well as both renal veins. The patient urinated by post-operative day 2. Function improved daily, with creatinine stabilizing at 0.4 mg/dL by one month. Serial ultrasounds showed persistent patency of the IVC and bilateral renal veins. The patient was heterozygous for the Factor V Leiden mutation and pathology demonstrated evidence of placental thrombosis. We have shown that neonatal anuric renal failure secondary to bilateral renal vein thrombosis can be successfully managed with early surgical thrombectomy without the need for nephrectomy. Restoration of renal function after surgical thrombectomy in this patient illustrates the potential reversibility of acute renal failure even in severe cases.