Fact-sheet: Renal vein thrombosis


Updated on 09/20/2019 at 10:24 AM

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Definition

Obstruction of the renal vein most often by a bland (cruoric) thrombus, more rarely tumoral.
The left renal vein is longer, passing through the aortomesenteric clamp, receiving the ovarian or spermatic vein and lumbar veins.
The right renal vein is shorter.

Thrombosis may be of intraluminal or extraluminal origin due to extrinsic compression.

Clinical features

Risk factors:

  • Virchow's triad (thromboembolic disease)
  • Extension of gonadal vein thrombosis
  • Secondary to a loco-regional neoplasm, particularly renal
  • Nephrotic syndrome

Variable clinical presentation:

  • Flank pain / hematuria
  • Asymptomatic

Laboratory findings

Increased thrombotic markers (D-dimers), as in any thromboembolic disease.
Possible worsening of renal function

Radiography

Noncontributory

Ultrasound

Ultrasound:

  • Echogenic thrombus within the renal vein
  • Hypo- or hyperechogenicity of the renal cortex
  • Late findings include renal atrophy and loss of corticomedullary differentiation
  • Assessment of extension into the IVC
  • May be limited by overlying bowel loops

Doppler:

  • Partial or complete loss of flow in the vein
  • Increased resistive index in the interlobar arteries in the initial phase (returning to normal once collateral venous network develops)

CT

  • Floating thrombus in the renal vein
  • Dilated vein
  • Infiltration of the periureteral fat along the course
  • Development of a collateral venous network
  • Extension to the IVC/contralateral renal vein/pulmonary embolism
  • Delayed renal secretion and excretion

MRI

Endoluminal filling defect within the dilated venous axis

Management

Anticoagulant therapy,

management of the predisposing factor

Differential diagnosis

Any cause of hematuria and flank pain

Neoplastic thrombus