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      A Case of Isolated Unilateral Right Renal Vein Thrombosis Associated with Bilateral Pulmonary Embolism Treated with Rivaroxaban a Direct-Acting Oral Anticoagulant

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          Abstract

          Patient: Female, 44

          Final Diagnosis: Renal vein thrombosis

          Symptoms: Dyspnea

          Medication: —

          Clinical Procedure: —

          Specialty: Cardiology

          Objective:

          Rare disease

          Background:

          Renal vein thrombosis is uncommon and can be associated with nephrotic syndrome. It is associated with high patient morbidity, and it may lead to thromboembolic event.

          Case Report:

          A 44-year-old woman presented with shortness of breath, chest pain and tightness, due to bilateral pulmonary embolism originating from right renal vein thrombosis. The diagnosis was made by transthoracic echocardiography and enhanced computed tomography (CT) scan of chest, abdomen, and pelvis. No underlying diseases were found. She was treated with heparin infusion therapy and rivaroxaban with good clinical outcome.

          Conclusions:

          A rare case is presented of isolated unilateral right renal vein thrombosis diagnosed following bilateral pulmonary embolism in a previously healthy 44-year-old woman, which was successfully treated with the DOAC, rivaroxaban.

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          Most cited references9

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          Epidemiology and pathophysiology of nephrotic syndrome-associated thromboembolic disease.

          After infections, thromboembolism is considered by many experts to be the most significant life-threatening complication of nephrotic syndrome. The purpose of this review is to summarize the epidemiology, clinical and molecular pathophysiology, and management of this complication. Children (2.8%) are less likely than adults (26.7%) with nephrotic syndrome to develop thromboembolism. However, infants and children aged >12 years are at much greater risk. Membranous histologic changes increase thromboembolic risk at all ages; in particular, adults with membranous nephropathy have the highest reported risk (37.0%) and children with membranous histology have a rate (25%) that approaches the overall adult rate. There are striking, but variable, pathologic alterations of molecular hemostasis associated with nephrotic syndrome. No clear molecular therapeutic targets have been identified, but most studies show that the major pathologic changes involve antithrombin, fibrinogen, and factors V and VIII. There is inadequate evidence to support routine prophylactic therapy. Therapy includes anticoagulation in all cases, with thrombolysis reserved for those with the most severe thromboembolic disease. Future hemostatic research in nephrotic syndrome should focus on identifying cohorts at highest risk for thrombosis through the use of clinical markers and biomarkers as well as searching for molecular targets to correct the prothrombotic pathophysiology of this disease.
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            Thromboembolic complications in the nephrotic syndrome: pathophysiology and clinical management.

            Patients with the nephrotic syndrome are at increased risk of developing venous and arterial thromboembolism, the most common of which is renal vein thrombosis. There are several unanswered or controversial issues relating to the nephrotic syndrome and thromboembolism, which include the mechanism of thromboembolism, and optimal diagnostic and anticoagulant management strategies. This review will discuss several of these issues: the epidemiology and clinical spectrum of thromboembolic disease occurring in patients with the nephrotic syndrome; the pathophysiology of the hypercoagulable state associated with the nephrotic syndrome; the diagnosis of renal vein thrombosis in the nephrotic syndrome; and the evidence for prophylactic and therapeutic anticoagulation strategies in such patients.
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              Renal vein thrombosis.

              The aim of this article is to review the published English literature on aetiology, pathology, clinical presentation, diagnostic methods and treatment of renal vein thrombosis. We searched the published literature from Medline & Pubmed using keywords renal vein thrombosis, anti-phospholipid syndrome and nephrotic syndrome. Data was extracted from individual case reports, case series, articles on pathology, diagnostic tests, treatment modalities, and previous reviews. Case reports which did not add any new information were excluded. We selected 60 references based on the above criteria. Renal vein thrombosis is relatively rare. CT angiography is considered the investigation of choice. Alternatives include MR angiography or renal venography in highly selected patients. As the condition is relatively uncommon, consensus on the best form of therapy for this condition has been slow to evolve. The trend in management has shifted to non-surgical therapies particularly systemic anticoagulation except in highly selected group of patients.
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                Author and article information

                Journal
                Am J Case Rep
                Am J Case Rep
                amjcaserep
                The American Journal of Case Reports
                International Scientific Literature, Inc.
                1941-5923
                2019
                06 August 2019
                : 20
                : 1152-1154
                Affiliations
                [1 ]Faculty of Medicine, Holy Spirit University of Kaslik, Kaslik, Lebanon
                [2 ]Department of Cardiology, Rangueil Hospital, Toulouse, France
                [3 ]Department of Internal Medicine College of Medicine, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
                [4 ]Department of Cardiovascular, Notre Dame des Secours University Hospital, Jbeil, Lebanon
                Author notes

                Authors’ Contribution:

                [A]

                Study Design

                [B]

                Data Collection

                [C]

                Statistical Analysis

                [D]

                Data Interpretation

                [E]

                Manuscript Preparation

                [F]

                Literature Search

                [G]

                Funds Collection

                Conflict of interest: None declared

                Corresponding Author: Anthony Matta, e-mail: dr.anthonymatta@ 123456hotmail.com
                Article
                916638
                10.12659/AJCR.916638
                6691838
                31383838
                206506ea-db10-41cb-a41e-ac2710ac5d6d
                © Am J Case Rep, 2019

                This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International ( CC BY-NC-ND 4.0)

                History
                : 30 March 2019
                : 15 May 2019
                Categories
                Articles

                pulmonary embolism,renal veins,thromboembolism
                pulmonary embolism, renal veins, thromboembolism

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