Internal Medicine

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

1292 Renal Osteodystrophy Renal Vein Thrombosis

■Anemia unresponsive to erythropoietin due to marrow fibrosis

■Acceleration of atherosclerosis by calcification of arteries

■Arrhythmias from calcification of conduction system

Prognosis

■Good if PO4 and Ca kept near normal

■Increased mortality when P >6.5 mg/dL or Ca×PO4 product >72

■Prognosis with calciphylaxis is extremely poor; sepsis leading cause

of death

RENAL VEIN THROMBOSIS

STEPHEN C. TEXTOR, MD

history & physical

■Acute thrombosis produces pain:flank/loin pain

➣hematuria

➣Fever

➣Worsening proteinuria

➣Testicular pain and swelling (left renal vein)

■Chronic thrombosis – often asymptomatic

➣worsening proteinuria

➣loss of renal function in solitary kidney or if bilateral

➣First manifestation may be pulmonary embolus

■Acute thrombosis may be associated with clotting disorders

elsewhere, e.g. antiphospholipid syndrome, venous trauma (e.g.

surgery/venography/manipulation); renal allograft rejection, vena

cava occlusion

■Chronic thrombosis often associated with nephrotic syndrome,

particularly membranous nephropathy, renal cell carcinoma, or

retroperitoneal fibrosis or other veno-occlusive diseases. Incidence

estimated between 10–40% of overtly nephrotic patients.

tests

■Basic tests: creatinine elevation

■Urinalysis: hematuria/nephrotic sediment with heavy proteinuria

■Screening for hypercoagulable states: Protein S deficiency screen,

protein C and antithrombin III are common inherited disorders with

8–10 fold relative increase in thrombotic events. Absolute risk not

certain.

■Imaging: