Renal Venous Occlusion



Renal vein occlusion is a thrombotic event. The incidence of renal vein thrombosis (RVT) is high in nephrotic glomerulopathies, especially mem­branous nephropathy, and in certain neoplastic diseases. Renal vein thrombosis may occur in children who develop severe volume depletion accompanying a gastrointestinal disorder.

Renal vein thrombosis most often occurs in the absence of direct clinical symptoms. However, two distinct patterns of clinical presentation have been recognized. Acute renal failure is often seen in children or in patients with the nephrotic syn­drome who have a reduced but stable baseline GFR. The second mode of presentation is that of acute pulmonary embolism and infarction, seen most often in patients with the nephrotic syn­drome.

Renal vein thrombosis can often be diagnosed safely with renal ultrasonography, but renal ven­ography may be required for definitive diagnosis in some patients. Prophylactic anticoagulant ther­apy in patients with nephrotic glomerulopathies, the group at highest risk for RVT, is not of proven use. Acute anticoagulant therapy is indicated in cases of proven or threatened pulmonary embo­lism; an improvement in renal function may occur.