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Renal Vein Thrombosis

Blood is filtered in the kidneys, then returns to the heart via the renal veins. A thrombus (blood clot) lodged in a renal vein impedes this flow.

What is it?

Renal vein thrombosis (RVT), an uncommon disorder, is a blood clot in one or both of the veins that carries blood from the kidneys back to the heart. In infants, the condition may occur suddenly and result in kidney failure and severe acute illness. In adults, the condition may produce no symptoms. In many cases, blood clots may also lodge in a pulmonary artery, where the clot, known as an embolism, may produce chest pain and shortness of breath (see Pulmonary Embolism for more information).

What Causes It?

  • In adults, renal vein thrombosis is almost always a result of nephrotic syndrome (see Nephrotic Syndrome for more information), although there are other causes.
  • Diarrhea with severe dehydration is the most common cause in children.
  • An injury to the abdomen or lower back may result in RVT.
  • Malignant kidney tumors that extend into the renal vein can lead to RVT.
  • Pregnancy or the use of oral contraceptives increases the risk.

Prevention

  • Preventive use of anticoagulant drugs (such as warfarin) may be recommended in high-risk individuals who have massive amounts of protein in the urine.

Diagnosis

  • Patient history and physical examination.
  • Urine sample.
  • Renal venography (injection of a contrast material into the renal vein prior to x-rays), ultrasound scans, or MRI (magnetic resonance imaging) may be performed to locate a blood clot.

How to Treat It

  • Streptokinase or urokinase (enzymes) may be administered to dissolve blood clots in severe cases of renal vein thrombosis of both renal veins associated with acute kidney failure.
  • Anticoagulant medications may be prescribed on a long-term basis to reduce the risk of pulmonary and renal vein clots.
  • In infants with life-threatening cases, surgical removal of the affected kidney may be required.

When to Call a Doctor

  • Call a doctor if you develop nagging, persistent pain in the lower back or side, or if you have nephrotic syndrome and experience shortness of breath and chest pain.