Internal Medicine

0521779407-18 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 8:1

Renal Vein Thrombosis 1293

➣Routine imaging of nephrotic subjects is not usually performed.

Often first consideration when abnormal pulmonary ventila-

tion/perfusion scan noted.

■Vena Cavagram and renal venogram are “gold standards”. MRA

angiography or CT scans can delineate extent and location of throm-

bus within the main renal vein and vena cava. Doppler ultrasound

may identify lack of flow within renal vein but is operator depen-

dent.

differential diagnosis

■Loss of renal function and/or pain related to other disorders, includ-

ing primary glomerular diseases.

■Must exclude renal arterial occlusion and/or nephrolithiasis, extrin-

sic renal vein compression (e.g. retroperitoneal fibrosis).

management

■Exclude other causes of reversible acute renal failure

■Hydration, volume expansion

■anticoagulation: Risks/benefits of anticoagulation in asymptomatic

RVT are uncertain and depend upon probability of embolic events.

Avoidance of high risk venous stasis and edema (e.g. use of support

hose) are preferred.

■Anticoagulation for established disease.

■role for thrombolytic therapy uncertain

specific therapy

■For established RVT and embolic events

➣Heparin followed by oral warfarin

➣Anticoagulation-oral coumadin until prothrombin INR 2.0–3.0

➣anticoagulation should be continued as long as nephrotic state

persists

➣Inferior Vena Cava Filter (Greenfield Filter) may be considered if

anticoagulation contraindicated or failure

follow-up

n/a

complications and prognosis

■Often asymptomatic with little or no clinical effect on proteinuria or

renal function.

■Occasional embolic events with pulmonary emboli and/or systemic

emboli when intracardiac defect, e.g. atrial septal defect