Renal Vein Thrombosis - Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

Renal vein thrombosis

Renal vein thrombosis is an occlusion (compression) of one or more veins that penetrate the kidney. This pathology leads to the development of acute or chronic renal failure. Renal vein thrombosis is not an independent disease, but acts as a complication of many conditions. Some of them directly interfere with blood flow in the organ, while others contribute to increased blood clotting.

Renal vein thrombosis is a rare phenomenon, it can develop in both an adult and an infant. The defeat can be one - and two-sided.

Content:

• Causes of renal vein thrombosis
• Renal vein thrombosis symptoms
• Diagnosis of renal vein thrombosis
• Treatment of renal vein thrombosis
• Prevention of renal vein thrombosis

Causes of renal vein thrombosis

The causes of renal vein thrombosis can be as follows:

• A tumor in the kidney that puts pressure on a vein.
• Violation of blood clotting against the background of severe vomiting, diarrhea, or excessive diuresis.
• Sepsis of newborns. Also, in childhood, renal vein thrombosis can occur if the mother suffers from diabetes mellitus, or the baby has a birth trauma to the organ.
• Nephrotic syndrome, which is accompanied by the loss of low molecular weight proteins by the body with urine. Renal vein thrombosis is observed, on average, in 35% of patients with nephrotic syndrome, regardless of what exactly caused it. Often renal vein thrombosis develops in patients with membrane nephropathy (in 10-15% of cases). This condition aggravates proteinuria, but the very blockage of the renal vein rarely leads to the development of nephrotic syndrome.
• Autoimmune diseases, such as active systemic lupus erythematosus.
• Proliferative glomerulonephritis, sickle cell nephropathy, renal vasculitis.

• Long-term use of corticosteroid drugs in high doses.
• Primary disorders of blood coagulation properties, for example, antithrombin 3 deficiency, prothrombin 620210A mutations, etc.
• The development of thrombosis is possible when the body rejects the established allograft.
• The risk of developing pathology increases during pregnancy.
• Rare causes of renal vein thrombosis include oral contraceptives, kidney injury, acute pancreatitis, and migratory thrombophlebitis.

It is impossible to exclude the "causeless" development of kidney thrombosis in the postpartum period in a woman. Also, medical science knows venous thrombosis in an implanted kidney.

Renal vein thrombosis symptoms

Most often, the onset of thrombosis goes unnoticed by the patient. Pronounced disturbances in well-being occur as the occlusion increases.

Symptoms of renal vein thrombosis in adults:

• Pain in the abdomen, which are localized on the sides, lower back pain. They can be so intense that they reach the level of renal colic.
• Sometimes it is not pain that comes to the fore, but the increasing edema of the lower extremities and external genital organs.
• Nausea and vomiting.
• Discharge of urine with blood.
• Increased urine protein.
• A sharp limitation of the amount of urine excreted.
• Increase in blood levels of urea and creatinine to high values.
• A ruptured kidney or organ infarction is observed when the patient develops severe urinary stasis.
• Increased blood pressure accompanied by back pain.
• An increase in body temperature, which is caused by the inflammatory process.

If young people most often experience a sharp development of the disease with a sudden onset and a gradual increase in symptoms of acute renal failure, then in older people the clinical picture is somewhat different. Their thrombosis progresses slowly, and its only sign is often an increase in blood pressure. Alternatively, patients may experience repeated pulmonary embolism. There are known cases when thrombosis of the renal veins proceeded according to the type of Fanconi syndrome and the type of renal proximal acidosis.

Symptoms of renal vein thrombosis in infants:

• Severe abdominal pain.
• Urine staining red due to the presence of blood in it.
• The presence of protein in the urine.
• In the lumbar region, a tumor-like formation may form.

In children, symptoms of acute renal failure are growing much faster than in adults.

Diagnosis of renal vein thrombosis

Diagnosis of renal vein thrombosis is reduced to a thorough history taking. It is necessary to clarify with the patient whether thrombosis was traced in his close relatives, it is important whether the patient smokes or not. It also plays a role in whether the woman is taking oral contraceptives.

For a long time, angiography has been used to diagnose renal vein thrombosis, but modern treatment standards dictate different rules. In particular, we are talking about the use of multislice computed tomography. Moreover, it is tomography that is best given preference in case of suspected renal vein thrombosis, since this procedure does not require the introduction of a contrast agent. The fact is that all contrasts have a greater or lesser nephrotoxic effect, that is, they negatively affect the state of the kidney. At a time when the organ already suffers from functional disorders, diagnostic methods should be as gentle as possible.

Do not underestimate such a diagnostic method as ultrasound. Doppler ultrasonography can be used to detect renal vein thrombosis, but it should be borne in mind that there is a high probability of obtaining a false negative result.

It is imperative to conduct laboratory research methods that allow you to clarify the diagnosis. The doctor collects blood and urine from the patient for analysis. The doctor must carry out a differential diagnosis and distinguish between renal vein thrombosis and urolithiasis, which is especially important for young people.

Treatment of renal vein thrombosis

Operative methods of intervention for venous thrombosis are rarely used as the main methods of treatment. As a rule, a good effect can be achieved with the timely use of anticoagulant drugs. To do this, heparin sodium is administered intravenously. Warfarin is prescribed for a long time, but only on the condition that the patient does not have to undergo surgery to remove a blood clot. In parallel, it is necessary to correct metabolic disorders in the body.

Reception of anticoagulants minimizes the risk of recurrent renal vein thrombosis, makes it possible to recanalize the vascular lumen, and improves kidney function. Treatment can be prescribed for a period of six months to a year. Provided that the patient has disorders in the blood coagulation system, then anticoagulant therapy will be prescribed for life.

If the need arises, then thrombolytic drugs are injected directly into the renal vein, designed to destroy the formed clot. Streptokinase is injected drip, the initial dose of the drug is 250,000 PU for half an hour. If after this time there is no increase in body temperature, then the drug is administered 6 more times, increasing the dose to 750,000 PU.

After the main treatment has been carried out, antispasmodics, pain relievers, drugs to lower blood pressure, drugs to improve the blood supply to the kidneys and to normalize urine output can be prescribed to normalize the patient's condition.

Renal vein thrombectomy is performed only when symptoms of acute renal failure are rapidly increasing, or there are contraindications to the administration of thrombolytics. Other indications for emergency surgery: bilateral renal vein thrombosis, complete kidney infarction, the presence of a tumor requiring removal. Nephrectomy, that is, complete removal of the organ, is performed only when a complete kidney infarction occurs, or the reason that led to venous thrombosis requires it.

In order to prevent a relapse of the disease and prevent thromboembolic complications, patients who have undergone renal vein thrombosis are shown a cava filter. It is inserted into the suprarenal inferior vena cava.

The prognosis for renal vein thrombosis is most often favorable. The probability of death of a patient remains extremely low, especially in the context of the provision of qualified medical care. The fatal outcome most often occurs due to pulmonary embolism, a torn off thrombus, or against the background of the development of severe complications in the form of nephrotic syndrome. Naturally, when making a prognosis, it is necessary to take into account the reason that led to the development of renal vein thrombosis. So, it will be the least favorable against the background of the patient having a malignant tumor.

Prevention of renal vein thrombosis

Prevention of renal vein thrombosis is reduced to regular monitoring by a doctor about the underlying disease. This is especially true for people with nephrotic syndrome, as well as other risk factors for the development of pathology. Moreover, one of the features of thrombosis in nephrotic syndrome is its asymptomatic course, which does not reduce the risk of pathology.

The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist

Education: Moscow State University of Medicine and Dentistry (1996). In 2003, he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.