Renal vein thrombosis (RVT) is a relatively rare condition in which a clot occludes the renal vein draining blood from the kidney and leads to renal vein infarction [1]. The exact reason why there is a predilection of the renal vein for thrombosis in as yet unknown [2]. It occurs most often in patients with nephrotic syndrome but can also affect patients with renal malignancies, anti-glomerular basement membrane disease [3], Behçet syndrome, hypercoagulable states like pregnancy [4], antiphospholipid antibody syndrome and following renal transplantation.

The clinical presentation of RVT in adults is usually insidious and asymptomatic. The first indication of the condition may be when the clot in the renal vein travels to the lungs causing pulmonary embolism with dyspnea and chest pain. Some cases may present with unilateral lower limb swelling. The onset is often sudden in children and some adults with fever, nausea, vomiting, flank pain, oliguria, gross hematuria, and proteinuria which progresses swiftly to renal failure especially in bilateral renal vein thrombosis or in patients with a single kidney [5]. The first symptom is usually flank pain occurring posterior to the lower ribs and in the region of the hips. In patients with renal malignancies, anorexia and weight loss may be predominant while patients with nephrotic syndrome may have anasarca.

• Sulfur Granules

  After nephrectomy, sulfur granules with chronic suppurative inflammation were seen microscopically, and the histopathological diagnosis was renal actinomycosis. Our case is the first report of renal actinomycosis with renal vein thrombosis. [ncbi.nlm.nih.gov]

• Pathologist

  First described by German pathologist Friedrich Daniel von Recklinghausen in 1861, RVT most commonly affects two subpopulations: newly born infants with blood clotting abnormalities or dehydration and adults with nephrotic syndrome.Nephrotic syndrome, [en.wikipedia.org]

• Gangrene

  We describe the case of a 10-year-old boy who developed this very unusual complication following appendectomy for gangrenous appendicitis with peritonitis. [ncbi.nlm.nih.gov]

• Vomiting

  A 31-year-old male with known atresia of the inferior vena cava who received a deceased donor renal transplant 7 years previously presented to hospital with severe graft site pain and a week of nausea, vomiting, and chills. [ncbi.nlm.nih.gov]

  Warfarin can cause rashes, diarrhea, nausea (feeling sick) or vomiting, and hair loss. [en.wikipedia.org]

  The onset is often sudden in children and some adults with fever, nausea, vomiting, flank pain, oliguria, gross hematuria, and proteinuria which progresses swiftly to renal failure especially in bilateral renal vein thrombosis or in patients with a single [symptoma.com]

  A 61-year-old woman whose medical history was notable for hypertension and type 2 diabetes reported a two-day history of increasing dull pain in the right flank and nonbloody, bilious vomiting. [nejm.org]

  However, onset may be acute, causing renal infarction with nausea, vomiting, flank pain, gross hematuria, and decreased urine output. [merckmanuals.com]

• Nausea

  Such patients may be asymptomatic, have minor nonspecific symptoms such as nausea or weakness, or have more specific symptoms such as upper abdominal pain, flank pain, or hematuria. [ncbi.nlm.nih.gov]

  The onset is often sudden in children and some adults with fever, nausea, vomiting, flank pain, oliguria, gross hematuria, and proteinuria which progresses swiftly to renal failure especially in bilateral renal vein thrombosis or in patients with a single [symptoma.com]

  However, onset may be acute, causing renal infarction with nausea, vomiting, flank pain, gross hematuria, and decreased urine output. [merckmanuals.com]

• Hypertension

  A 61-year-old woman whose medical history was notable for hypertension and type 2 diabetes reported a two-day history of increasing dull pain in the right flank and nonbloody, bilious vomiting. [nejm.org]

  […] artery disease - legs, Peripheral intravenous line - infants, Portacaval shunting, Pulmonary angiography, Pulmonary arteriovenous fistula, Pulmonary embolus, Renal arteriography, Renal cell carcinoma, Renal vein thrombosis, Renal venogram, Renovascular hypertension [ufhealth.org]

  Most patients (10 of 14) had generalized vague illness and nephrotic syndrome but 4 were initially seen with acute symptoms of flank pain, hematuria or hypertension. [ncbi.nlm.nih.gov]

  Characterized by:  Heavy proteinuria ( 3.5g in 24 hours) Hallmark  Hypoalbuminemia ( serum albumin 300mg/dl)  Edema /anasarca  Hypertension  Lipiduria  Hypercoagulabil ity 3.  Renal vein thrombosis (RVT) is common (around 40%) in patient with nephrotic [slideshare.net]

  Risk factors for renal vascular disease include: age female gender atherosclerosis hypertension, particularly new onset of hypertension in an older person smoking high cholesterol diabetes A risk factor is anything that may increase a person’s chance [surgery.med.miami.edu]

• Hydrops Fetalis

  Rapid deterioration of fetal condition, abnormal fetal Doppler, appearance of hydrops fetalis, may accompany fetal venous thrombosis. [ncbi.nlm.nih.gov]

  Prenat Diagn 2007;27:603-607. van der Vange N, Bruinse HW: Hydrops fetalis associated with inferior vena cava thrombosis. Eur J Obstet Gynecol Reprod Biol 1986;21:113-115. Rudolph N, Levin EJ: Hydrops fetalis with vena caval thrombosis in utero. [karger.com]

• Flank Pain

  RVT should always be included in the differential diagnosis of flank pain and hematuria, and because RVT can induce acute renal injury. A 19-year-old man was admitted to our hospital because he complained of right flank pain and oliguria for 3 days. [ncbi.nlm.nih.gov]

  The first symptom is usually flank pain occurring posterior to the lower ribs and in the region of the hips. In patients with renal malignancies, anorexia and weight loss may be predominant while patients with nephrotic syndrome may have anasarca. [symptoma.com]

• Hematuria

  A 38-year-old woman presented with flank pain and hematuria suggestive of renal calculus on ultrasound. [ncbi.nlm.nih.gov]

• Bladder Distention

  Here, we report a rare case of RVT that appears to have occurred as a consequence of obstructive uropathy causing massive bladder distention resulting in compression of the renal vein. [ncbi.nlm.nih.gov]

• Enlargement of the Prostate

  Imaging revealed bladder distension, enlargement of the prostate, bilateral hydronephrosis, and left renal vein thrombosis extending into the inferior vena cava. [ncbi.nlm.nih.gov]

Diagnosis in patients with RVT is difficult as the clinical presentation is often overshadowed by anasarca or weight loss and anemia due to the predisposing conditions like nephrotic syndrome and renal malignancies respectively. Routine laboratory tests like complete blood count, urinalysis, serum blood urea nitrogen (BUN) and creatinine levels may reveal anemia, oliguria/proteinuria, and elevated BUN/ creatinine levels due to renal dysfunction.

The diagnosis of RVT is based on radiological tests. Ultrasonography in the acute stage may reveal renal enlargement with hyperechogenicity [6] and is the first radiological investigation to be performed although it cannot confirm the diagnosis. Computed tomogram with angiography (CTA) is the gold standard investigation with almost 100% sensitivity and specificity [7] as it can detect the occluding thrombus with abnormal renal perfusion [8]. The radiologist can also deduce the presence of a thrombus on CTA indirectly due to signs of renal enlargement, renal vein dilatation, poor renal venous drainage on a nephrogram, delayed corticomedullary differentiation, and renal fascial thickening [7]. Instead of a CTA, magnetic resonance imaging (MRI) is preferred in patients with renal impairment as it can be performed without using nephrotoxic contrast [9]. However, it has a lower sensitivity and specificity as compared to CTA [10].

• Escherichia Coli in Blood Culture

  Urine cultures were positive for Escherichia coli and blood cultures were negative. After 5 days of antibiotic therapy with cefuroxime, inflammatory parameters (CRP level and white blood cell count) remained highly elevated. [ncbi.nlm.nih.gov]

• Amyloid Plaque

  Read More Full Text HTML Download PDF Figure 1: Alzheimer's disease (AD) is characterized by neuronal death, which is usually correlated with the appearance of amyloid plaques and neurofibrillary tangles (NFTs). (a) The Aβ pathway leading... [doi.org]

• Neurofibrillary Tangle

  Read More Full Text HTML Download PDF Figure 1: Alzheimer's disease (AD) is characterized by neuronal death, which is usually correlated with the appearance of amyloid plaques and neurofibrillary tangles (NFTs). (a) The Aβ pathway leading... [doi.org]

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2. Harris SL, Smith MP, Laurie A, Darlow BA. Neonatal renal vein thrombosis and prothrombotic risk. Acta Paediatr. 2010 Jul;99(7):1104-7.
3. Bailey P, Sarfraz F, Ravanan R. Anti-GBM disease and renal vein thrombosis. BMJ Case Rep. 2011 Nov 15;
4. Mouhsine A, Belkouch A, El Mehdi A et al. Renal vein thrombosis in the postpartum period: a case report. J.Med Case Rep. 2014; 8:462
5. Harrison CV, Milne MD, Steiner RE. Clinical aspects of renal vein thrombosis. QJ Med. 1956;25:285–301.
6. Ricci MA, Lloyd DA. Renal venous thrombosis in infants and children. Arch Surg. 1990;125:1195–1199. doi: 10.1001/archsurg.1990.01410210121019.
7. Alvarez-Castells A, Sebastia CC, Quiroga GS. Computerized tomography angiography of renal vessels. Arch Esp Urol. 2001;54:603–615.
8. Kawashima A, Sandler CM, Ernst RD, et al. CT evaluation of renovascular disease. Radiographics. 2000;20 (5):1321-40.
9. Tempany CM, Morton RA, Marshall FF. MRI of the renal veins: assessment of nonneoplastic venous thrombosis. J Comput Assist Tomogr. 1992;16 (6): 929-34.
10. Hodgson DJ, Jan W, Rankin S, et al. Magnetic resonance renal angiography and venography: an analysis of 111 consecutive scans before donor nephrectomy. BJU Int. 2006;97:584–586.