Case Of Renal Vein Thrombosis Research Articles

En Bloc Simultaneous Liver–Kidney Transplantation Compared to the Traditional Technique: Results From a Single Center

Introduction: Simultaneous liver-kidney transplantation is indicated for patients with concomitant end-stage liver disease and end-stage renal disease. The traditional technique involves separate implantations of the liver and the kidney. In the en bloc approach, the liver is recovered en bloc with the right kidney and the donor renal artery is anastomosed to the donor splenic artery.Objective: To compare the outcomes of the traditional and en bloc techniques for simultaneous liver-kidney transplantation in a single center.Methods: Single-center retrospective study involving all adult patients who underwent simultaneous liver-kidney transplantation with brain-dead donors from January/2017 to December/2022.Results: A total of 15 patients were included, being 10 transplanted with the traditional technique and 5 with the en bloc one. Patients in the en bloc group presented higher body mass index, shorter cold and total kidney ischemia time, shorter overall surgical time and longer kidney ischemia time (29.07 vs 23.20kg/m2, p=0.048; 560 vs 880min, p=0.026; 615 vs 908min, p=0.025; 405 vs 485min, p =0.046; 46 vs 33.5min, p=0.027, respectively). Ureteroneocystostomy was performed in 2 patients of the en bloc group and ureteroureterostomy in the remaining 3 patients. One patient in the en bloc group presented stenosis of renal artery anastomosis and underwent percutaneous angioplasty. This same patient eventually developed late urinary fistula. In the traditional technique group, there were two cases of renal vein thrombosis and one of ureteral stenosis.Conclusion: Compared to the traditional technique, the en bloc approach is feasible and safe, reducing the total surgical and kidney ischemia times.

Tromboembolismo venoso em Idade Pediátrica: Um olhar de 20 anos numa Unidade de Cuidados Intensivos Pediátricos

Objective: Clinical characterization and approach of patients with thromboembolism (VTE). Methods: Retrospective, descriptive study of patients aged <18 years with VTE in a pediatric intensive care unit in a tertiary care hospital over 20 years [2002-2021]. Results: Identified 51 patients: deep vein thrombosis (DVT) (n=30), cerebral vein thrombosis (CVT) (n=21), pulmonary thromboembolism (PTE) (n=4), portal vein thrombosis (PVT) (n=2) and renal vein thrombosis (RVT) (n=1). In 5 patients CVT and DVT coexisted (n=1); PTE and DVT (n=3); and RVT and DVT (n=1). Mean 2.6 cases/year. 52.3% male, median 6 years [1M;17Y]. The presence of a central venous catheter was the main risk factor (72%) in DVT associated with edema in the region; Doppler ultrasound was the exam of choice. All with PTE were adolescents; 75% had chest complaints confirmed by angio-CT; identified =2 risk factors in each patient. The case of RVT was a 2-year-old child with renal neoplasm. The cases of PVT were adolescents with symptoms of portal hypertension. The main symptom in CVT was headache (63.6); 52.4% secondary to upper respiratory infection; thrombophilia study positive in 42.9%. Analytically, all had elevated D-dimers. Most started anticoagulation with enoxaparin (86.3%), which they maintained for 3 to 6 months after discharge. Mean hospital stay was 17.6 days. There was 1 episode of recurrence and 1 death unrelated to VTE.

A Case of Proteinuria Developing Secondary to Solitary Renal Vein Thrombosis Due to Oral Contraceptive Use

Renal vein thrombosis (RVT) is the presence of thrombi in major renal veins or their branches and is a rare clinical entity. RVT is one of the common thrombotic complications of nephrotic syndrome or renal cell carcinoma. Hormonal contraception can also rarely cause this complication. Herein, we presented a case of renal vein thrombosis accompanied by subnephrotic proteinuria after oral contraception.

Effects of web-based self-management model on preventing renal vein thrombosis in patients with nephrotic syndrome

Objective To explore the effects of web-based self-management model on preventing renal vein thrombosis (RVT) in patients with nephrotic syndrome (NS) . Methods Totally 126 NS patients hospitalized in the First Affiliated Hospital of Zhengzhou University from June 2017 to June 2018 were selected by convenient sampling and divided into conventional management group (n=64) and web-based self-management group (n=62) by random draw. Patients in the conventional management group received routine discharge guidance, while patients in the web-based self-management group received comprehensive web-based self-management based on routine nursing, including education webpage, WeChat group, and SMS and phone alerts based on the telecommunications network. The incidence of RVT in the two groups was collected in the outpatient clinic 6 months after discharge. The Self-Efficacy Scale and Health Promoting Lifestyle Profile (HPLP-II) were used to evaluate the self-management efficacy and health behavior of the two groups on the day of discharge and 6 months after discharge. Results One cases of RVT occurred in the web-based self-management group (1 case was lost to follow-up) , and 8 cases of RVT occurred in the conventional management group (4 cases were lost to follow-up) . The incidence of RVT in the web-based self-management group was 1.64%, lower than 13.33% in the conventional management group, and the differences were statistically significant (χ2=6.008; P=0.014) . The scores of two dimensions as well as the total self-efficacy scores increased in both groups 6 months after discharge, and those of the web-based self-management group were higher than those of the conventional management group, and the differences were statistically significant (P< 0.01) . Compared with the day of discharge, the scores in different HPLP-II dimensions increased in both groups 6 months post discharge, and the differences were statistically significant (P< 0.01) . The scores of the web-based self-management group were higher than those of the conventional management group, and the differences were statistically significant (P< 0.01) . Conclusions The web-based self-management model can reduce the incidence of RVT in NS patients, and improve their self-efficacy, health behavior and self-management out of hospital. Key words: Nephrotic syndrome; Renal vein thrombosis; Self-management; Health behavior; Prevention; Web

MON-004 PROFILE AND OUTCOMES OF PRIMARY NEPHROTIC SYNDROME

Primary nephrotic syndrome encompasses a wide range of histopathological diagnoses with varied incidence, presentations, treatment options, response and outcomes based on geographical distribution, age, sex and the histopathological diagnosis. Our aim was to study the outcomes of primary nephrotic syndrome in our patient population. The study was conducted in two arms: retrospective arm (From 1st January 2013 to 28th February 2016) and prospective arm (1st March 2016 to 28th February 2017). All biopsy proven cases of primary nephrotic syndrome that were on regular follow up in the department of nephrology in our institute for a minimum of 6 months were included. Primary outcomes (treatment responses) and secondary outcomes (complications due to treatment or disease per se) were studied. Total 196 patients (140 retrospective and 56 prospective) were included. The mean age of patients was 33.6±17.7 years with male to female of 2:1. The most common etiological diagnosis was idiopathic membranous nephropathy (MN) in 36.7% followed by minimal change disease (MCD) in 28.1%, focal segmental glomerulosclerosis (FSGS) in 20.9%, membranoproliferative glomerulonephritis (MPGN) in 9.7%, IgM nephropathy in 2.6% and IgA nephropathy in 2.0%. Oral prednisolone was used as the primary treatment in all cases except patients of MN where oral prednisolone along with either oral cyclophosphamide or tacrolimus was given. Secondary treatment was given to patients who showed no response, partial response or relapsed as well as steroid dependent patients. Secondary and in some cases tertiary treatment was given in the form of oral prednisolone combined with oral cyclophosphamide or tacrolimus or mycophenolate mofetil or rituximab intravenous infusion. The cumulative rate of complete remission was highest in MCD (93%), followed by FSGS (85%), MN (83%), IgM nephropathy (80%), primary MPGN (37%) and IgA nephropathy (25%). The rate of relapse was highest in IgM nephropathy (60%) followed by MCD (55%), FSGS (17%), and MN (11%). The rate of steroid dependence was 25% in MCD and 50% in IgM nephropathy. The rate of steroid resistance was 6% in MCD and 16% in FSGS. The rate of complete remission with oral prednisolone alone was 81% in MCD and 65% in FSGS. The rate of complete remission with oral prednisolone combined with oral cyclophosphamide was 83% in MCD and 57% with MN. The complete remission rate on oral prednisolone combined with tacrolimus was 85% in MN, 81% in MCD and 78% in FSGS. Secondary outcomes included complications such as pneumonia in 19 cases, urinary tract infection in 12 cases, diabetes mellitus due to tacrolimus in 11 cases and neutropenia due to cyclophosphamide in 11 cases. Five cases of MCD had spontaneous bacterial peritonitis. Two cases of deep vein thrombosis and one case of renal vein thrombosis were seen in membranous nephropathy. The profile of nephrotic syndrome and the therapeutic options used have shown a favorable response to outcomes of primary nephrotic syndrome with the exception of MPGN and IgA nephropathy.

A rare case of renal vein thrombosis due to urinary obstruction.

Renal vein thrombosis (RVT) is an uncommon condition in adults and may be caused by endothelial damage, stasis, or hypercoagulable states. RVT is commonly identified in patients with nephrotic syndrome or malignancy. We present the case of a 57-yearold man with no past medical history who presented with a 1-month history of abdominal pain, dysuria, and hematuria. Initial laboratory studies were consistent with acute kidney injury (AKI). Imaging revealed bladder distension, enlargement of the prostate, bilateral hydronephrosis, and left renal vein thrombosis extending into the inferior vena cava. His renal failure and presenting symptoms resolved with placement of a Foley catheter and ureteral stent. The patient was discharged on anticoagulation. Here, we report a rare case of RVT that appears to have occurred as a consequence of obstructive uropathy causing massive bladder distention resulting in compression of the renal vein.

Large Bladder Clot—An Unusual Presentation of Neonatal Bilateral Renal Vein Thrombosis—Case Report and Review of Literature

A 1-day-old boy born at 37 weeks gestation presented with hematuria, thrombocytopenia, and palpable irregular right flank mass. Renal ultrasound demonstrated large clot within the bladder, bilateral kidney masses with loss of corticomedullary differentiation, and reversal of diastolic flow. The patient was diagnosed with bilateral renal vein thrombosis and was managed conservatively. There was complete resolution of the bladder clot with restoration of corticomedullary differentiation bilaterally. We report the first case of renal vein thrombosis associated with a large bladder clot in a neonate.

A case of renal vein thrombosis with adrenal haemorrhage

Sri Lanka Journal of Child Health , 2014; 43 (3): 174-176 (Key words: Renal vein thrombosis; adrenal haemorrhage) DOI: http://dx.doi.org/10.4038/sljch.v43i3.7382

Renal failure due to renal vein thrombosis in a fetus with growth restriction and thrombophilia

We report a case of renal vein thrombosis diagnosed at 27 weeks of gestation in a dichorionic twin pregnancy. The left kidney of one fetus was hyperechoic and enlarged with echoic streaks following the direction of interlobular veins and the loss of corticomedullary differentiation. In the following weeks, left kidney became smaller and echoic, and Doppler examination showed no flow in both artery and vein. The right kidney had totally normal appearance in the beginning, but it became enlarged and hyperechoic, and progressed into a small echoic kidney with no flow in artery and vein. In the postnatal ultrasound examination, both kidneys appeared hyperechoic with no vascularization in the hilum region. There was thrombosis in arteries and veins of both kidneys, as well as in the inferior vena cava. The investigation for thrombophilia resulted with the combined presence of heterozygote mutation in factor V Leiden and prothrombin 20210 genes.

Acute Pyelonephritis: The clot unfolds

We report a case of Renal Vein Thrombosis (RVT) thought to be a complication of actue pyelonephritis in a 44 year old female presenting to the acute medical take. The most common cause of RVT is nephrotic syndrome, due to a hyper-coaguable state. RVT is also seen in renal cell carcinoma due to tumour invasion. A possible theory relating RVT to acute pyelonephritis may relate to concomitant thrombophlebitis of the renal vein in pyelonephritis, which then predisposes to thrombosis. The patient was subsequently investigated for possible causes of this thrombotic event and anticoagulated. The management of RVT is also discussed. We hope this case highlights the importance of keeping an open mind and adding to the original management when a new, but unexpected finding is made.

A Case of Renal Vein Thrombosis in a Patient with Ulcerative Colitis

Venous thrombosis and thromboembolism appear to occur more often in patient with inflammatory bowel disease (IBD). The cause of thrombotic complications in IBD is generally considered to be associated with hypercoagulable conditions. Its prevalence rate ranges from 1% to 8% in clinical studies and rises to 39% in autopsy, but the renal vein thrombosis is very rare complication in ulcerative colitis patient. A 24-year-old man presented with intermittent abdominal pain and hematochezia for 6 months and recently developed pitting edema for few weeks. He was diagnosed as severe ulcerative colitis involving whole colon combined with thrombosis in both renal veins by colonoscopy and computed tomography scan of abdomen. We used steroid for the treatment of ulcerative colitis and both intravenous lower molecular weight heparin and warfarin for renal vein thrombosis. His symptoms were improved after treatment and maintained with mesalazine and warfarin. Follow-up abdominal CT scan showed complete resolution of both renal vein thrombosis. Currently he has been followed up for 2 years with oral mesalazine.

Ipsilateral Placement in Double-Kidney Transplantation: An Old Technique in a New Fashion

We read with interest the communication of Gaber et al. (1) from Memphis, Tennessee describing the ipsilateral (monolateral) placement of both adult deceased donor kidneys into a single recipient in double (dual) kidney transplantation (DKT). The first DKT was reported in 1996 by Johnson et al. (2) as shown in Gaber et al. article. The authors mentioned that there was no prior description available for monolateral positioning of DKT (MPDKT). We report that the first description of MPDKT was published in 1998 by Masson and Hefty (3) with a very similar figure of the technique as published by the Memphis group. In that report, no such detailed description of ipsilateral technique was given but the technique was described briefly. However, as it was the first report with the detailed figure of the technique, we believe that it should have been mentioned in such surgical technique article. Besides the first report by Masson and Hefty, we recently published 29 cases of MPDKT from marginal donors in an “old-for-old” allocation policy (4). In our report, we described the MPDKT technique in ample details in comparison with the first report and we provided a detailed figure of our technique in MPDKT. Interestingly, Gaber et al. (1) did not provide the figure of their surgical technique, especially of interest in vascular anastomoses. The authors mentioned that the preference of arterial anastomosis for the first kidney is proximal internal iliac artery after suture ligation of the distal end (1). However, the surgical artwork shows an end-to-side anastomosis, which is an option for the authors and which was already shown by Masson and Hefty (3) and our group (4). Besides, the authors described the same technique for ureteral anastomosis (combined) as Masson and Hefty. Approximately a decade after the description of the MPDKT in an adult recipient, the usage of DKT has recently blossomed because of the important increase of older deceased donors and their optimal usage at long term (5). The assessment of preoperative biopsy of older donor kidneys could be of help to the surgeons to perform either DKT, single kidney transplantation, or discard them (5, 6). The MPDKT has had particular interests reducing the operating time and surgical trauma, and leaving the contralateral iliac fossa for further retransplantation as much as it had many doubts because of compression of the anastomosed vessels and surgical hurdles of the technique itself especially on older recipients. Our group has reached more than 65 cases of MPDKTs using the described technique in previously published article (4) and we have experienced only one case of renal vein thrombosis in a patient with a heterozygousy for Factor V Leiden gene mutation (4, Ekser and Rigotti, Unpublished data). The question remains whether the technique described by the Memphis group would result in an actual novelty as a surgical procedure and also in the graft outcomes. We think that our previously described and refined surgical technique has so far yielded excellent operative and survival data. Burcin Ekser Lucrezia Furian Paolo Rigotti Kidney and Pancreas Transplantation Unit Department of Surgery and Organ Transplantation University of Padua Padua, Italy

Elevated maternal lipoprotein (a) and neonatal renal vein thrombosis: a case report

IntroductionRenal vein thrombosis, although rare in adults, is well recognized in neonates and is one of the most common manifestations of neonatal thromboembolic events. The etiology of renal vein thrombosis remains unidentified in the majority of cases. We report a case of renal vein thrombosis in a neonate associated with elevated maternal lipoprotein (a).Case presentationA full-term female infant, appropriate for gestational age, was born via spontaneous vaginal delivery to an 18-year-old primigravida. The infant's birth weight was 3680 g and the Apgar scores were eight and nine at 1 and 5 minutes respectively. Evaluation of the infant in the newborn nursery revealed a palpable mass in the right lumbar area. Tests revealed hematuria and a high serum creatinine level of 1.5 mg/dl. An abdominal ultrasound Doppler flow study demonstrated an enlarged right kidney, right renal vein thrombosis, and progression of the thrombosis to the inferior vena cava. There was no evidence of saggital sinus thrombosis. An extensive work-up of parents for hypercoagulable conditions was remarkable for a higher plasma lipoprotein (a) level of 73 mg/dl and an elevated fibrinogen level of 512 mg/dl in the mother. All paternal levels were normal. The plasma lipoprotein (a) level in the neonate was also normal. The neonate was treated with low molecular weight heparin (enoxaparin) at 1.5 mg/kg/day every 12 hours for 2 months, at which time a follow-up ultrasound Doppler flow study showed resolution of the thrombosis in both the renal vein and the inferior vena cava.ConclusionThere have been no studies to date that have explored the effect of abnormal maternal risk factors on fetal hemostasis. A case-control study is required to investigate whether elevated levels of maternal lipoprotein (a) may be a risk factor for neonatal thrombotic processes. Although infants with this presentation are typically treated with anticoagulation, there is a lack of evidence-based guidelines. Treatment modalities vary between study and treatment centers which warrants the establishment of a national registry.

Fetal MRI: what is the future?

Fetal MRI: what is the future?

A Fulminant Case of Renal Vein Thrombosis in a Patient with Autoimmune Disorder and Membranous Nephropathy

A previously healthy middle-aged woman noted a rapid onset of flank pain with gross hematuria. Enhanced CT scan showed thrombosis of the inferior vena cava and right renal vein. Laboratory findings revealed nephrotic proteinuria, Sjogren's syndrome (SjS), and Graves' disease (GD). A right nephrectomy was performed because of progressive and refractory renal necrosis. Renal specimens showed venous infarction with diffuse hemorrhagic and severe congestive renal necrosis, and membranous nephropathy (MN). The present case was diagnosed as acute renal necrosis due to catastrophic thrombosis in a patient with SjS, GD, and MN. It was thought that sudden development of thrombosis may have been caused by the status of the autoimmune disorders, and the associated MN.

Infected renal CYST: Unusual cause of renal vein thrombosis

Cases of renal vein thrombosis following infectious kidney diseases have been rarely described [Siqueira-Filho AG, Kottke BA, Miller WE. Primary inferior vena cava thrombosis: report of nine cases. Arch Intern Med 1976;136:799–802]. There have been few cases of renal vein thrombosis accompanying a xantogranulomatous pyelonephritis and a pyonephrosis. Literature reveals no case of renal vein thrombosis developing secondary to an infected renal cyst [Mitchell DG, Friedman AC, Druy EM, Swanberg LE, Phillips M. Xanthogranulomatous perinephritis: unusual cause of renal vein and vena caval thrombosis. Urol Radiol 1985;7:35–8]. This report presents the first case of unilateral infected renal cyst with thrombosis of the renal vein.

Combined Percutaneous Mechanical and Chemical Thrombectomy for Renal Vein Thrombosis in Kidney Transplant Recipients

Renal vein thrombosis occurring after the immediate post-transplant period often leads to loss of the transplant organ. We report two cases of renal vein thrombosis in the setting of de novo membranous nephropathy occurring 5 and 26 months post-transplantation. Both cases were treated with percutaneous mechanical thrombectomy and localized catheter-directed thrombolysis with resolution of clot burden, and regained kidney function after thrombolysis without subsequent thromboses. Percutaneous mechanical thrombolysis can be safely done in renal transplant recipients and should be considered in patients with renal vein thrombosis beyond the immediate post-operative period in order to minimize exposure to systemic thrombolysis.

Thrombose veineuse rénale néonatale et double hétérozygotie pour le facteur V Leiden et la prothrombine

We report a case of renal vein thrombosis, treated with heparin and thrombolytic therapy, in a patient who was heterozygous for both factor V Leiden and prothrombin mutations. Case report. – A full-term infant was treated with heparin and fibrinolytics at the fourth day of life because of renal vein thrombosis, inferior vena cava thrombosis and adrenal hemorrhage. After four days of treatment, the repermeabilization was complete but a renal atrophy developed. The investigation for congenital coagulation disorders revealed a heterozygous mutation for both factor V Leiden and prothrombin. Conclusion. - Search for inborn blood coagulation disorders should be systematic in the newborn infant with venous thrombosis because of the risk of recurrence, even in the presence of a known acquired risk factor. The thrombolytic treatment improves the prognosis.

Successful surgical thrombectomy of renal allograft vein thrombosis in the early postoperative period

We report the successful surgical treatment of two cases of renal vein thrombosis, each occurring early after kidney transplantation. Prompt intervention was a result of accurate diagnosis by color Doppler ultrasonography. Invasive radiological procedures were not useful. Although recent advances in thrombolytic therapy have created several alternatives to open surgery, the rationale for surgical exploration in these cases was to remove the thrombus quickly, to avoid the postoperative bleeding complications of thrombolytic therapy, and to correct any technical or anatomic problems.

ANTI-CD45 MONOCLONAL ANTIBODY PERFUSION OF HUMAN RENAL ALLOGRAFTS PRIOR TO TRANSPLANTATION A SAFETY AND IMMUNOHISTOLOGICAL STUDY

The perfusion of kidneys with anti-CD45 monoclonal antibodies prior to transplantation offers a means of targeting passenger antigen-presenting cells with the aim of reducing the subsequent incidence of rejection episodes. A safety study was performed in humans of such pretreatment in 40 unsensitized recipients of first cadaveric renal grafts, who were followed for 3 months after transplantation. A 50-ml solution containing 2 mg of each of the rat anti-CD45 mAbs YTH 24.5 and YTH 54.12 was injected into the allograft renal artery ex vivo and just before transplantation while the renal vein was kept clamped. No patients died, but 4 grafts were lost. Two were lost due to primary nonfunction, 1 was lost because of late renal artery thrombosis, and 1 was lost to rejection. There were no cases of renal vein thrombosis and 1 trivial renal artery stenosis, and only 2 patients produced human anti-rat antibodies. Between 63.5% and 100% (median 96.4%) of CD45+ cells in the postperfusion biopsies were coated with anti-CD45 as determined by double-immunolabeling. The number of patients experiencing rejection episodes was inversely associated with this "antibody uptake": 75% of the low uptake group (< 95%) had at least 1 rejection episode, compared with 22% of the high uptake group (> or = 95%) (P = 0.001). The complement components C3 and C5b-9 colocalized with perfused anti-CD45 in 32/33 (97.0%) and 11/33 (33.3%) of the biopsy specimens, respectively. We conclude that: (1) this technique appears free of adverse effects, (2) high antibody uptake within the kidney is associated with a lower incidence of rejection, and (3) the antibodies used fix and activate complement in vivo.