Update on Guidelines for the Management of Cancer‐Associated Thrombosis
What To Know About Renal Vein Thrombosis
Renal vein thrombosis (RVT) is when a blood clot develops anywhere along the renal vein. This is the vein that drains blood from the kidneys. RVT is rare but can be life threatening.
People with renal vein thrombosis (RVT) have a blood clot, also known as a thrombus, in the vein that carries blood away from their kidneys.
If a thrombus grows so large that it completely blocks the renal vein, the kidneys swell and cannot function properly. The person may experience acute pain in their side. They may also notice a reduced need to urinate, and they may have blood in their urine.
The renal veins join the inferior vena cava, which is the main vein returning blood to the heart. If any part of a renal vein thrombosis breaks away from the main clot, it can travel to the lungs. Blood clots here can be fatal.
This article explains what RVT is and how doctors treat it. It also looks at ways of preventing it and reducing the risk factors.
People with RVT may have clots on just one side, but according to a 2023 paper, most people have clots on both sides.
Although anyone can develop RVT, most people with it have underlying kidney diseases or have had a kidney transplant. Some infections and injuries can also increase the risk of RVT.
Most people with RVT have nephrotic syndrome, where the kidneys leak protein into the urine.
Blood clots can also form if the veins are damaged. This can happen due to a back injury or trauma to the abdomen.
Very occasionally, infants develop RVT, particularly if they are severely dehydrated or have very low blood pressure.
Having nephrotic syndrome significantly increases a person's risk of developing RVT, according to a 2023 paper. Other risk factors include:
The Centers for Disease Control and Prevention (CDC) notes that the risk of developing a deep vein thrombosis (DVT), such as RVT, increases with age. They add that some people develop blood clots after having catheter treatment in a central vein.
Healthcare professionals know that people with severe COVID-19 infections, particularly those who require hospital treatment, have a higher chance of blood clots, including RVT and hypercoagulability disorders. In a 2022 case study, healthcare professionals recorded how they successfully treated a person with RVT, which was caused by COVID-19.
Many people with RVT do not have any symptoms, and healthcare professionals discover the blood clots during imaging tests for other purposes. However, when people do experience symptoms, they are often not immediately obvious. Symptoms include:
Healthcare professionals cannot diagnose RVT through a physical exam, but they may be able to feel if the kidneys are swollen. They may also test the person's urine for proteins and blood.
Researchers explain that healthcare professionals usually recommend imaging tests, including ultrasounds and CT scans. They state that although renal venography is the gold standard test for RVT, many healthcare professionals prefer to use less invasive tests. Renal venography is when a healthcare professional injects a dye into the person's veins and then takes an X-ray of the kidneys to see how the blood flows.
Doctors may recommend CT angiography, which is a similar test but produces a more detailed picture of the person's kidneys and blood supply. They may also recommend magnetic resonance angiography (MRA), which is similar to a CT scan but does not use X-rays.
Many people with RVT have an underlying kidney disease, so healthcare professionals tailor their treatments to take that into consideration.
They may prescribe anticoagulants to thin the person's blood. A 2023 case study records how doctors successfully treated a person's RVT with rivaroxaban (Xarelto). Healthcare professionals may also prescribe heparin and warfarin to stop other clots from forming.
People with untreated RVT have a risk of kidney damage, which can lead to chronic (long-term) kidney disease.
The CDC notes that if parts of the clot break away, they can travel to the person's lungs, causing a pulmonary embolism (PE).
PEs can be life threatening and need immediate medical treatment. If a person has difficulty breathing, chest pain that gets worse after coughing, or coughs up blood, they need to see a doctor as this is an emergency.
There is very little research on how to prevent RVT, as most people with it have underlying kidney problems. However, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) offers some tips for keeping kidneys healthy. These include:
Most people with RVT respond well to treatment. However, the outlook depends on the underlying cause, and a person may need additional treatment.
Healthcare professionals may continue to prescribe anticoagulants to prevent people from developing additional clots.
A notes in people who have RVT following a kidney transplant, their bodies have usually rejected the organ.
Renal vein thrombosis (RVT) is when a blood clot forms in a person's renal veins, which take blood away from the kidneys.
It can happen to anyone, but most people with RVT have underlying kidney problems, such as nephrotic syndrome. Other common causes include kidney cancers or having a kidney transplant.
Doctors treat RVT with anticoagulants and will also treat the underlying causes.
Overview Of Ex Vivo Renal Artery Reconstruction Surgery
Ex vivo renal artery reconstruction is an extensive procedure used to treat complex aneurysms of the artery that supplies your kidney. It involves removing your kidney, repairing the artery, and transplanting your kidney back.
Ex vivo renal artery reconstruction and autotransplantation, often shortened to ex vivo renal artery reconstruction, is a surgical technique for treating a renal artery aneurysm. A renal artery aneurysm is a weakened and expanded section of the blood vessel that supplies your kidney.
"Ex vivo" means outside of your body. "Autotransplantation" means to transplant your own tissue.
The procedure involves temporarily removing your kidney, repairing the artery, and then retransplanting your kidney. It's usually reserved for complex aneurysms that involve multiple branches of your renal artery or the part of your renal artery closest to your kidney.
Read on to learn more about this procedure, including when you might need it, what to expect during the procedure, and potential complications.
Ex vivo renal artery reconstruction is used to treat renal artery aneurysms. It's an elective surgery to prevent the aneurysm from rupturing.
Renal artery aneurysms occur in 0.1–2.5% of people in the larger population. They are usually diagnosed during imaging for unrelated reasons. A rupture of the renal artery is a medical emergency. It has a high risk of death.
An ex vivo renal artery reconstruction is used to treat complex aneurysms that involve multiple branches of your renal artery or the parts of your artery close to your kidney. For simpler procedures, doctors may perform the repair using techniques that don't require the removal of your kidney.
Current evidence supports that renal artery aneurysms should be repaired if they exceed 3 centimeters (1.2 inches) in diameter or if they occur in people with:
In a 2022 review, researchers reported complications in 6.9% of 199 people who received ex vivo renal artery reconstruction.
The most common complications were:
Ex vivo renal artery reconstruction can be highly effective at treating aneurysms in your renal artery, especially when the surgery may be too difficult to perform using other surgical techniques.
It's often the surgery of choice when the kidney needs to be disconnected from its blood supply for more than 30–60 minutes.
According to a 2019 case report and review, some studies have found that up to 100% of people had blood flow through their renal artery at a 1-year follow-up. Other studies report mortality rates from 0–9.6%.
Here's a general idea of what to expect before, during, and after an ex vivo renal artery reconstruction.
Before the procedureBefore your procedure, your care team orders tests, like a chest X-ray or blood tests, to measure your overall health. You may be told to stop taking certain medications, such as blood thinners.
Before your procedure, doctors administer general anesthetics through an intravenous (IV) line to put you to sleep.
During the procedureDoctors can perform the surgery through a large incision or with a small incision using a thin tube called a laparoscope.
Here's a general idea of what to expect if your surgeon performs the surgery through a large incision:
When you wake up in the recovery room, you'll be connected to a urinary catheter, IV, and other devices to measure your vitals. You can drink fluids shortly after waking and may be able to eat a light meal several hours later.
Your care team will likely give you blood-thinning medications to help avoid the development of blood clots.
You typically won't be able to eat for at least 6 hours and drink at least 2 hours before your procedure. Follow your doctor's instructions, as this time is sometimes longer.
You won't be able to drive after your procedure, so it's important to prepare a ride home in advance.
Doctors often recommend quitting smoking before procedures that require general anesthesia to reduce your chances of complications.
Most people can leave the hospital about a week after a kidney transplant. You should be able to return to work and your usual activities within a few months if serious complications don't develop.
To give you a rough idea of the cost, the nonprofit FAIR Health estimates that more than 80% of procedures to repair a complex aneurysm of a neck artery in Boston are less than $22,142, with anesthesia potentially costing another $6,669.
The nonprofit estimates that 80% of procedures to remove a kidney and transplant a donor's kidney cost less than $16,789 in Boston, with anesthesia potentially costing another $4,713.
Many insurance programs, including Medicare, cover at least part of the cost if it's a medically necessary procedure, but it's essential to check your coverage in advance.
Ex vivo renal artery reconstruction is usually reserved for complex aneurysms. For simpler procedures, your doctor may use other surgical techniques that don't require removing your kidney.
Both open and endovascular techniques can be used to repair a renal artery aneurysm. Open surgery involves repairing your renal artery through a large incision. Endovascular surgery involves repairing it with special tools that are inserted into your blood vessels.
Undergoing an ex vivo renal artery reconstruction can help prevent the rupture of a renal artery aneurysm, but it does come with some risks of complications.
Your doctor can advise whether they think your aneurysm needs treatment and what the best treatment option may be.
A Rare Case Of Renal Infarction Caused By Infective Endocarditis
Background. A 29-year-old man presented to the emergency department of a general hospital complaining of sudden onset left loin pain, radiating to the groin, which had started 48 h previously. He described no urological symptoms and had no medical history of note.
Investigations. Physical examination, electrocardiography, dipstick testing of urine, radiography of the chest and abdomen, blood tests (white blood cell count and serum urea, creatinine, sodium, potassium and C-reactive protein levels), CT of the renal tract, blood and urine cultures, renal angiography, thromboembolic blood panel, urine and blood tests for illicit drugs, transthoracic echocardiography, transesophageal echocardiography, renal ultrasonography.
Diagnosis. Infective endocarditis resulting in thromboembolic unilateral renal infarction.
Management. The patient was started on anticoagulation therapy with low-molecular-weight heparin and treated with intravenous gentamicin and benzylpenicillin for 4 weeks. He was seen in an outpatient clinic 4 weeks after discharge, at which time serum urea and creatinine levels and repeat ultrasonography of the renal tract confirmed normal renal function. He will be followed up regularly by cardiologists and urologists, at 6 weeks initially, and every 6 months to 1 year thereafter by his family physician.
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