Renal Vein Thrombosis

In adults, the most common cause of renal vein thrombosis is

• Nephrotic syndrome

In nephrotic syndrome, large amounts of protein are lost in the urine and the blood has an increased tendency to form clots.

Renal vein thrombosis may also be caused by kidney cancer or conditions that put pressure on the renal vein (for example, a tumor) or on the inferior vena cava, into which the renal vein drains. Other possible causes are blood clotting disorders (hypercoagulability disorders), vasculitis, systemic lupus erythematosus (lupus), sickle cell disease or diabetes that affects the kidneys, oral contraceptive use, injury, , or (rarely) thrombophlebitis migrans—a condition in which clotting occurs sequentially in different veins all over the body.

Renal vein thrombosis occurs most often in adults. In adults, onset and progression are usually gradual and without symptoms. An occasional clue to doctors is when a piece of clot breaks off and travels from the renal vein to the lungs (pulmonary embolism). This event causes sudden shortness of breath and pain in the chest that is made worse by breathing. In other people, urine production diminishes.

In most children and a limited number of adults, onset and progression are usually sudden. Pain, often the first symptom, typically occurs in the back behind the lower ribs and in the hips. The person may have fever, nausea, vomiting, less than a normal amount of urine, and blood in the urine.

• Blood and urine tests

• Imaging tests

Blood tests may indicate evidence of a decrease in the ability of the kidneys to process and excrete the body's waste products (kidney failure). Routine urine testing is also done.

Magnetic resonance (MR) angiography, Doppler ultrasonography, and computed tomography (CT) angiography are the tests doctors use to diagnose renal vein thrombosis (see Imaging Tests of the Urinary Tract). MR angiography and CT angiography are highly accurate and do not require insertion of a catheter into an artery or a vein deep in the body. Ultrasonography is not as accurate, but it is very safe. Ultrasonography shows enlarged kidneys if the blockage developed suddenly. Doppler ultrasonography may show that there is no blood flowing in the renal vein. X-rays of the inferior vena cava or the renal vein that are taken after a radiopaque contrast agent is injected into an artery or deep vein (venography) is the most accurate test but may cause clots to break off and travel through the bloodstream, becoming emboli, which can cause complications.

• Treatment of the underlying disorder

• Drugs that prevent or dissolve blood clots

• Rarely, surgery

The underlying disorder is treated.

Treatment of renal vein thrombosis includes anticoagulant drugs, which usually improve kidney function by preventing the formation of additional clots and reducing the risk of pulmonary embolism. Generally a catheter is inserted into the vein to give a drug that dissolves clots (fibrinolytic) and sometimes to remove the clot (called thrombectomy). Rarely, surgery is done to remove clots in the renal vein.

The outcome depends on the cause of the thrombosis, complications, and the degree of kidney damage. Death from renal vein thrombosis is rare and usually results from a fatal underlying disorder or from complications, such as a pulmonary embolism. The effects on kidney function depend on whether one or both kidneys are affected, whether blood flow is restored, and what the state of kidney function was before the blockage occurred.

The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

1. American Association of Kidney Patients (AAKP): AAKP improves the lives of patients through education, advocacy, and promotion of a sense of community among patients with kidney disease.

2. American Kidney Fund (AKF): AKF provides information about kidney disease and kidney transplant, needs-based financial assistance to help manage medical expenses, webinars for medical professionals, and opportunities for advocacy.

3. National Kidney Foundation (NKF): This clearinghouse provides everything from information on the basics of kidney function to access to treatment and support for people with kidney disease, continuing medical education courses, and research opportunities and grant support for medical professionals.

4. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): General information on kidney diseases, including research discoveries, statistics, and community health and outreach programs.