Complete renal recovery from severe acute renal failure after thrombolysis of bilateral renal vein thrombosis

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Abstract

A previously healthy young man presented with acute renal failure due to extensive spontaneous deep vein thrombosis, including the inferior vena cava (IVC) and both renal veins. The patient was treated with selectively delivered thrombolytic therapy over a 7-day-period, which resulted in renal vein patency and complete recovery of renal function. A stent was placed over a segment stenosis of the IVC. No thrombophilic factors were identified. Bilateral renal vein thrombosis in young fit individuals is an unusual cause of acute renal failure. Thrombolytic therapy, even with delay, can completely restore renal function.

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Most cited references 10

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Congenital absence of the inferior vena cava: a rare risk factor for idiopathic deep-vein thrombosis.

A Tosetto, M Ruggeri, G Castaman … (2001)

Congenital absence of the inferior vena cava (AIVC) is a rare vascular defect, commonly reported as a fortuitous finding. The presence of AIVC in patients with DVT is underestimated because AIVC cannot be detected by compression B-mode ultrasonography. By use of computed tomography, we diagnosed four cases of AIVC in young patients with idiopathic DVT over a 5 year period. Based on the occurrence of DVT in patients below 30 years in our area during the same period, we estimate that AIVC is present in about 5% of cases of DVT in young patients. Computed tomography or angiography should be used for the diagnosis of idiopathic DVT in young patients.

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Inferior vena cava malformation as a risk factor for deep venous thrombosis in the young.

Clifford H. Watson, Annabel Y. -M. Chee, D. Culligan (2001)

Conditions which result in hypercoagulable blood or venous stasis may predispose to the development of deep vein thrombosis (DVT). Most of the recently described risk factors for DVT induce a hypercoagulable state. Over a 3-year period we have observed anomaly of the inferior vena cava (IVC) in four young patients presenting with spontaneous unprovoked DVT. This is a greater than expected rate (5% observed versus 0.5% expected). Further, bilateral DVT, which constitutes less than 10% of cases in most series, was present in three of the four cases. Anomaly of the IVC is a rare example of a prevalent congenital condition that predisposes to DVT, presumably by favouring venous stasis. This diagnosis should be considered in young patients with spontaneous and bilateral DVT.

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Obstructive lesions of the inferior vena cava: clinical features and endovenous treatment.

Kathryn Hollis, S Raju, Peter Neglén (2006)

Chronic obstructions of the inferior vena cava (IVC) are associated with many odd features. Even total occlusions may remain entirely silent or present late with acute symptoms. Renal dysfunction is rare. Many have chronic symptoms, but often only one limb is affected. We describe the clinical features in a series of 120 patients seen over a 10-year period and the results of successful stent placement in 99 limbs. Patients with acute onset of symptoms due to distal thromboses underwent catheter-directed thrombolysis. Patients with significant chronic symptoms were investigated by duplex, venous function tests, transfemoral venography and finally intravascular ultrasound (IVUS). Stenotic segments were balloon dilated and occluded segments were recannalized when feasible; stents were placed under IVUS control. In the asymptomatic group, 10 patients with total occlusions had transient or no occlusive symptoms. In the acute symptom group, four patients with chronic IVC occlusions presented with acute onset of deep venous thrombosis distal to the occlusion but became asymptomatic when the clot was lysed. In the chronic symptom group, 97 patients (99 limbs) had symptoms of chronic venous disease of variable distribution and intensity. In two-thirds, limb symptoms were unilateral. Pathology was total occlusion in 14%, and the rest were stenoses. The lesion extended above the renal vein in 18%. Common iliac obstruction was concurrent in 93%. Distal reflux was present in 66%. Modifications of the basic stent technique were required in recanalization of total occlusions (four extending up to the atrium), two bilateral stent deployments, and nine IVC filter cases. Stent deployment across the renal and hepatic veins or the contralateral iliac vein had no adverse sequelae. Stent patency (cumulative) at 2 years was 82%. Complete relief (cumulative) of pain and swelling at 3.5 years was 74% and 51%, respectively. The cumulative rate of complete ulcer healing at 2 years was 63%. Overall clinical outcome was rated as good or excellent in 70%. The unusual clinical features of IVC obstructions seem related to the rich collateralization, which has an embryonic basis. Common iliac vein patency seems to be a crucial link in collateral function, and its concurrent occlusion produces symptoms. Percutaneous stent placement has an emerging role in the treatment of IVC obstructive lesions, with good mid-term stent patency and clinical results.

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Journal

Journal ID (nlm-ta): Clin Kidney J

Journal ID (iso-abbrev): Clin Kidney J

Journal ID (publisher-id): ckj

Journal ID (hwp): ndtplus

Title: Clinical Kidney Journal

Publisher: Oxford University Press

ISSN (Print): 2048-8505

ISSN (Electronic): 2048-8513

Publication date (Print): October 2012

Publication date PMC-release: October 2012

Volume: 5

Issue: 5

Pages: 428-430

Affiliations

[1 ]Department of Medicine, Worcestershire Royal Hospital , Worcester, UK

[2 ]Department of Radiology, University Hospital Birmingham NHS Foundation Trust , Birmingham, UK

[3 ]Department of Renal Medicine, University Hospital Birmingham NHS Foundation Trust , Birmingham, UK

Author notes

Correspondence and offprint requests to: Suresh Ramadoss; E-mail: drsureshr@ 123456hotmail.com

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Publisher ID: sfs118

DOI: 10.1093/ckj/sfs118

PMC ID: 4432425

PubMed ID: 26019821

SO-VID: 96c5e794-fa3f-4dd2-be6e-b6a06d1b8253

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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

Complete renal recovery from severe acute renal failure after thrombolysis of bilateral renal vein thrombosis

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Karger: Nephrology

Most cited references 10

Congenital absence of the inferior vena cava: a rare risk factor for idiopathic deep-vein thrombosis.

Inferior vena cava malformation as a risk factor for deep venous thrombosis in the young.

Obstructive lesions of the inferior vena cava: clinical features and endovenous treatment.

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