Renal vein thrombosis

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Classification according to ICD-10
I82.3 Embolism and thrombosis of the renal vein
ICD-10 online (WHO version 2019)

The renal vein thrombosis is a vascular disease wherein a blood clot ( thrombus ) in the renal vein (vena renalis) has formed. Symptoms are flank pain and bloody urine (macrohematuria) . The triggering causes are usually cancer or a nephrotic syndrome . The diagnosis is made by computed tomography , Doppler sonography, or magnetic resonance imaging . The treatment is carried out with the anticoagulant drugs heparin and Marcumar .

Triggering causes

Usually a triggering cause can be proven. The most common cause (66% of cases) is cancer , predominantly renal cell carcinoma followed by nephrotic syndrome (20% of cases), mostly due to membranous glomerulonephritis . Renal vein thromboses without a demonstrable cause (idiopathic renal vein thrombosis) are rare. In contrast to deep vein thrombosis , the risk of renal vein thrombosis is not increased if there is a familial burden with venous thromboembolism or injuries . After surgical interventions , the risk of renal vein thrombosis is only increased if a kidney transplant has been performed .

The age distribution is twofold with a slightly increased frequency in the first two decades of life and a significant increase in diseases beyond the age of 70. Sepsis , dehydration and cystic kidneys were described as causes in the first month of life ; Causes in the first two decades of life were nephroblastoma , nephrotic syndrome , protein C deficiency, kidney transplantation , sepsis and dehydration.

The left renal vein is affected in 43% of cases, the right renal vein in 33% and both renal veins in 21%. In 43% of cases, the thrombus extends into the inferior vena cava (inferior vena cava).

clinic

The most common symptoms are flank pain in 73% of cases and bloody urine (macrohematuria) in 36% of cases. Nonspecific complaints such as loss of appetite , nausea and fever are common (> 40% of cases). In half of the cases, the physical examination reveals a tremor in the hands (asterixis) .

laboratory

In more than half of the cases, there is a reduction in kidney function and increased protein excretion in the urine . Kidney failure requiring dialysis is present in 5 percent of cases and nephrotic syndrome in 20 percent of cases .

In individual cases, a protein S deficiency or antithrombin deficiency were described as part of an extended coagulation diagnosis.

diagnosis

The diagnosis is made using imaging methods such as computed tomography , Doppler sonography , magnetic resonance imaging with gadolinium as a contrast medium, and arterioscopy or venography .

therapy

The treatment is usually with anticoagulant drugs heparin and warfarin . The treatment is usually carried out for at least 6 months, possibly for life. Rare acetylsalicylic acid , fibrinolysis or Cavaschirm used.

forecast

Older studies report recurrence rates of 8.5% to 27% after renal vein thrombosis . In a more recent study, repeated thromboembolic events were rare (1 in 100 patient-years). It was mostly a deep vein thrombosis; recurrence of renal vein thrombosis has not been described.

If the kidney vein thrombosis is caused by cancer or an infection, life expectancy is reduced. In patients with renal vein thrombosis due to nephrotic syndrome, there are no restrictions on life expectancy. Therapy with warfarin (in Germany Marcumar is usually used instead ) improves the prognosis .

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