Bilateral Renal Venous Thrombosis Research Articles

2083710 Perinatal Renal Vein Thrombosis; Review of 6 Cases

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.

Sonography of renal venous thrombosis in neonates and infants: can we predict outcome?

The relationship between sonographic features of renal venous thrombosis (RVT) and outcome has not been described in a large series of patients. To analyze sonographic findings of RVT and their evolution in a large series of patients and to attempt to identify features that might predict outcome. Retrospective analysis of sonograms and medical records of neonates and infants diagnosed with RVT during the period 1998-2007. Of 22 children (mean age: 3 days; age range: 0-107 days), RVT was bilateral in 12. Of 34 affected kidneys, thrombus in the main renal vein was seen in 17 and typical RVT sonographic findings without main renal vein thrombus were seen in the remaining 17. All children had US follow-up (range: 0.6-97.2 months). Three children with bilateral RVT died. Nine kidneys atrophied. Imaging findings associated with subsequent kidney atrophy included markedly reduced perfusion at diagnosis, subcapsular collections, patchy cortical echotexture and profoundly hypoechoic and irregular renal pyramids. Six patients (eight kidneys) presented with renal calcifications on initial sonogram before 7 days of life, suggesting antenatal RVT. Sonography is useful in neonatal and early infant RVT and might help predict renal atrophy. Antenatal RVT appears to be relatively common.

Tissue plasminogen activator therapy for renal venous thrombosis

Renal venous thrombosis (RVT) is a well-recognised and potentially fatal entity in children, and approximately 80% of RVTs present in the first month of life.1 Management of RVT remains controversial....

Bilateral renal venous thrombosis and adrenal hemorrhage: sequential prenatal US with postnatal recovery

A neonate presented with bilateral renal venous thrombosis (RVT) and adrenal hemorrhage. Serial fetal ultrasonography showed progressive development of severe atrophy of one kidney and mild atrophy of the other. At sequential postnatal imaging, both kidneys showed progressive growth. Bilateral fetal RVT is quite uncommon, and postnatal recovery of a kidney severely affected by RVT is very rare.

Renal Outcome of Neonatal Renal Venous Thrombosis: Review of 28 Patients and Effectiveness of Fibrinolytics and Heparin in 10 Patients

Neonatal renal venous thrombosis is a rare disorder that can result in severe renal damage. To evaluate the experience over 10 years and review the effectiveness of fibrinolytic and/or heparin therapy, chart reviews were performed for newborns with renal venous thrombosis. PATIENTS, INTERVENTIONS, AND OUTCOME MEASURES: Twenty-eight newborns with renal venous thrombosis were treated at Children's Hospitals and Clinics of Minnesota and Fairview University Medical Center from 1991 to 2001. Unilateral involvement was noted in 25 neonates (89%) and bilateral involvement in 3 (11%). Unilateral renal venous thrombosis affected mostly term infants, whereas 2 of 3 infants with bilateral renal venous thrombosis were <32 weeks' gestational age (birth weight: 745-1505 g). One mother had antiphospholipid syndrome. Of 11 neonates evaluated for congenital thrombophilia, 1 had the factor V Leiden mutation. Ten neonates received either unfractionated or low molecular weight heparin for 3 days to 7 months. Three infants with unilateral renal venous thrombosis treated with heparin alone did not seem to benefit from such therapy. Seven neonates were treated with fibrinolytics and unfractionated heparin (4 neonates with unilateral renal venous thrombosis and 3 with bilateral renal venous thrombosis). Treatment with fibrinolytics did not result in restoration of renal function in the 4 neonates with unilateral renal venous thrombosis but was associated with return of almost normal function in the 2 neonates with bilateral renal venous thrombosis who received fibrinolytics immediately after renal venous thrombosis diagnosis. Two neonates treated with fibrinolytics suffered bleeding complications at the area of adrenal hemorrhage. Two neonates (not treated for renal venous thrombosis) died as a result of underlying disease. Most neonatal renal venous thrombosis is unilateral and does not respond to fibrinolytic therapy and heparin. The use of fibrinolytics may prevent chronic renal failure in neonates with bilateral renal venous thrombosis if begun within 24 hours of diagnosis. Fibrinolytic therapy, however, is associated with a risk of bleeding, specifically if there is an associated adrenal hemorrhage.

Asynchronous bilateral renal venous thrombosis with subsequent development of cystic kidneys

Objective To discuss a case of asynchronous bilateral renal venous thrombosis with a review of current literature. Case A premature fraternal twin male was delivered via Cesarean section to a mother with a history of pre-eclampsia. He was initially diagnosed with a left renal venous thrombosis (RVT) but subsequently developed right RVT. Only intravenous fluids and supportive care were provided. Anticoagulation was withheld because of MRI findings of multiple areas of intracerebral bleeding. His serum creatinine concentration stabilized at 0.7 mg/dL, but follow-up renal ultrasound studies showed bilateral anechoic corticomedullary cysts. He also developed hypertension. Discussion Renal venous thrombosis usually occurs in neonates. Multiple clinical conditions are associated with RVT, two of which exist in this case. Recent work has focused on genetic prothrombotic risk factors, one of which our patient exhibits. Controversy exists over management, i.e. whether or not to initiate anticoagulation or antithrombotic therapy to decrease the development of renal atrophy, renal failure and hypertension. Conclusions This unusual case of asynchronous bilateral renal venous thrombosis recovered in the short term without antithrombotic therapy. Substantial insult early in life is reflected in the progressive worsening of his renal function, ultrasound findings and hypertension, highlighting the need for long-term vigilant observation of these patients.

Thrombophilia in neonatal renal venous and arterial thrombosis

Sirs, Renal venous thrombosis (RVT) is a classical disease in neonates, especially those that are preterm. It is a rare disorder with severe consequences for the affected kidney(s). A recent survey, carried out in Germany over a 2year period, identified 35 proven cases, corresponding to an incidence of 2.2 in 100,000 live births; half of these were premature [1]. Organ scarring was observed in 26 of the 39 affected kidneys. The clinical presentation consists of increased kidney size, macroor microhematuria, reduced urine output, and some degree of renal failure. Renal ultrasonography shows unior bilateral kidney enlargement with little flow and in many cases additional thrombi in the vena cava. The cause of RVT is unclear. The following predisposing factors have been identified in several earlier studies: maternal diabetes, traumatic delivery, prematurity, hyperviscosity, hypovolemia, and hemoconcentration. Recent single case observations have pointed to the association of RVT with activated protein C resistance, especially in bilateral cases [2, 3, 4, 5]. One multicenter case-control study in neonates and infants with abdominal venous thrombosis was published [6]. The odds ratio for RVT was 10.9 in infants with different forms of thrombophilia. Treatment remains controversial in the absence of trials to compare supporting therapy with anticoagulation and/or thrombolysis. Renal artery thrombosis (RAT) in the neonate is far less common than RVT, and there is little information about its incidence. It is strongly associated with umbilical catheters and patent ductus arteriosus [7]. The clinical presentation is rather silent and renal ultrasound findings can be minimal unless Doppler imaging is used. The outcome of the affected kidneys is poor with global atrophy being the rule. To the best of our knowledge, no patients with neonatal RAT and thrombophilia have been reported to date. Thrombophilia is an acquired or genetic state of hypercoagulability; the most common abnormalities being genetic in origin. Established genetic forms predisposing to venous thrombosis are deficiencies of antithrombin, protein C, and protein S, mutations in the promotor of the gene encoding prothrombin and factor V Leiden mutation. Mutations in the gene for methylenetetrahydofolate reductase, which lead to hyperhomocysteinemia, are associated with venous as well as arterial thrombosis. Over the last 25 years, ten patients were followed regularly in our Renal Unit for renal damage as a consequence of renal venous or arterial thrombosis in the neonatal period. There were eight boys and two girls. RVT was diagnosed in five patients, of whom two had bilateral thrombosis. RAT was observed in another five patients and was unilateral in all. The diagnosis of RVT was based on clinical, laboratory, and ultrasound manifestations. All patients had hematuria, thrombocytopenia, and kidney enlargement. The diagnosis of RAT was based on arterial hypertension, reduced kidney size, and poor renal perfusion. The two patients with bilateral RVT developed chronic renal failure. Of the five patients with RAT, three have complete atrophy of the affected kidney and two with a remnant kidney have needed antihypertensive drugs for several years. The investigations for thrombophilia were performed when the patients were aged between 18 months and 22 years. In two patients W. Proesmans · P. van de Wijdeven Renal Unit, Department of Pediatrics, University Hospital, Leuven, Belgium