Renal vein thrombosis

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Overview
Renal vein thrombosis (RVT) is the formation of a clot or thrombus obstructing the renal vein.

Epidemiology
Among patients with nephrotic syndrome, the incidence of real vein thrombosis is quite variable. Some reports place the incidence at 5% while others place it at 62%.

Pathophysiology
A hypercoagulable state or mechanical compression of the renal vein is often present in those patients with renal vein thrombosis. This can be due to malignancy or it can be due to the nephrotic syndrome. In nephrotic syndrome there is an excessive urinary protein loss which is in turn associated with decreased antithrombin III. It is unclear why the renal vein is susceptible to thrombosis in patients with nephrotic syndrome.

Common Causes

 * Nephritic syndrome (defined as >3 g/d protein loss in the urine, hypoalbuminemia, hypercholesterolemia, and edema)

Uncommon Causes

 * Antiphospholipid antibody syndrome
 * Behçet's syndrome
 * Hypercoagulable states
 * Kidney transplant
 * Renal cell carcinoma

Symptoms
Back or flank pain may be present. Hematuria may be present.

Diagnosis
CT angiography can be used in diagnosis.

Treatment
Surgery to remove the clot is possible, but rarely performed.

Anticoagulation therapy can have some benefits.