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Renal vein thrombosis

Definition

Renal vein thrombosis is a blood clot that develops in the vein that drains blood from the kidney.

Causes

Renal vein thrombosis is an uncommon disorder. It may be caused by:

• Abdominal aortic aneurysm

• Hypercoagulable state: clotting disorders

• Dehydration (mostly in infants)

• Estrogen use

• Nephrotic syndrome

• Pregnancy

• Scar formation with pressure on the renal vein

• Trauma (to the back or abdomen)

• Tumor

In adults, the most common cause is nephrotic syndrome. In infants, the most common cause is dehydration.

Symptoms

Symptoms may include:

• Blood clot to the lung

• Bloody urine

• Decreased urine output

• Flank pain or low back pain

Exams and Tests

An exam may not reveal the specific problem. However, it may indicate nephrotic syndrome or other causes of renal vein thrombosis.

Tests include:

• Abdominal CT scan

• Abdominal MRI

• Abdominal ultrasound

• Duplex Doppler exam of the renal veins

• Urinalysis may show protein in the urine or red blood cells in the urine

• X-ray of the kidney veins (venography)

Treatment

The treatment helps to prevent the formation of new clots and reduces the risk of clot traveling to other locations in the body (embolization).

You may get medicines that prevent blood clotting (anticoagulants). You may be told to rest in bed or cut down on activity for a short time.

If sudden kidney failure develops, you may need dialysis for a short period.

Outlook (Prognosis)

Renal vein thrombosis most often gets better over time without lasting damage to the kidneys.

Possible Complications

Complications may include:

• Acute renal failure (especially if thrombosis occurs in a dehydrated child)

• End stage renal disease

• Blood clot moves to the lungs (pulmonary embolism)

• Formation of new blood clots

When to Contact a Medical Professional

Contact your health care provider if you have symptoms of renal vein thrombosis.

If you have experienced renal vein thrombosis, call your provider if you have:

• Decrease in urine output

• Blood in the urine

• Breathing problems (due to blood clot moving to your lung called pulmonary embolism)

• Other new symptoms

Prevention

In most cases, there is no specific way to prevent renal vein thrombosis. Keeping enough fluids in the body may help reduce risk.

Aspirin is sometimes used to prevent renal vein thrombosis in people who have had a kidney transplant. Blood thinners such as warfarin may be recommended for some people with chronic kidney disease.

References

Augustine J, Wee AC, Krishnamurthi V, Goldfarb DA. Renal insufficiency and ischemic nephropathy. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 87.

DuBose TD, Santos RM. Vascular disorders of the kidney. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 116.

Greco BA, Umanath K. Renovascular hypertension and ischemic nephropathy. In: Feehally J, Floege J, Tonelli M, Johnson RJ, eds. Comprehensive Clinical Nephrology. 6th ed. Philadelphia, PA: Elsevier; 2019:chap 41.

Review Date: 4/12/2023

Reviewed By: Walead Latif, MD, Nephrologist and Clinical Associate Professor, Rutgers Medical School, Newark, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.