In renal vein thrombosis, a blood clot forms in a vein in the kidney. It is one of the vascular diseases and is usually the result of cancer.
What is renal vein thrombosis?
Renal vein thrombosis is a vascular disease. A thrombus forms in the renal vein (Vena renalis). Due to this vascular occlusion, blood congests within the kidney. In most cases, the thrombosis of the renal vein manifests itself only very discreetly. In some cases, the disease is completely asymptomatic. See etaizhou for What does Leisure Sickness Mean.
A life-threatening complication of renal vein thrombosis is pulmonary embolism. Here the blood clot migrates from the renal vein via the right heart into the lungs and blocks a pulmonary artery there. Despite this risk, patients with renal vein thrombosis are usually not operated on. Treatment is drug-based with anticoagulants.
A thrombosis is always based on a triad of reduced blood flow, increased coagulability of the blood and damage to the inner lining of the vessels. This Triassic is also called the Volhard Triassic. The main cause of renal vein thrombosis is cancer. In most cases, this is renal cell carcinoma or another tumor from the retroperitoneal space.
The second most common cause of renal vein thrombosis is nephrotic syndrome. Nephrotic syndrome is a symptom complex of proteinuria, hypoproteinemia, hyperlipoproteinemia, and edema. The syndrome usually develops on the basis of glomerulonephritis.
Other causes of renal vein thrombosis are dehydration (e.g. due to severe diarrhea or vomiting), metabolic disorders such as homocystinuria, autoimmune diseases or thrombophilia.
Venous thrombosis can also result from blunt trauma. Blunt trauma usually occurs in accidents. However, fights, abuse or entrapment can also cause blunt trauma and thus renal vein thrombosis. Some renal vein thrombosis occurs without a known cause. This form is also known as idiopathic renal vein thrombosis. In general, the following applies: After a previous kidney transplant, the risk of suffering from renal vein thrombosis is significantly increased.
Symptoms, Ailments & Signs
Renal vein thrombosis is often asymptomatic or very subtle. The most common symptom is pain in the flank area. 73 percent of all patients with a thrombosis of the renal vein suffer from flank pain. Bloody urine (macrohematuria) is found in 36 percent of cases. The amount of urine drops to less than 200 milliliters per square meter of body surface.
In medical jargon, this condition is called oliguria. Proteins are also excreted in the urine (proteinuria). Due to the loss of protein, water builds up in the tissue. This edema often shows up around the eyes. These complaints are accompanied by non-specific symptoms such as tiredness, nausea, fever or loss of appetite.
In 50 percent of all patients there is also a trembling of the hands (asterixis). If the thrombus resolves spontaneously, the symptoms change. Some of the symptoms go away. However, if irreversible vascular damage has occurred, some of the symptoms may persist even after the clot has dissolved.
Diagnosis & course of disease
The diagnosis of renal vein thrombosis is often only made when the kidney values suddenly deteriorate in patients with nephrotic syndrome or when kidney failure occurs. A reduction in kidney function can be determined in the laboratory. The glomerular filtration rate (GFR) is reduced. The creatinine concentration in the blood, on the other hand, is increased.
Substances from the urine remain in the blood. In isolated cases, there may be a lack of protein S or antithrombin in the blood. Red blood cells (erythrocytes) and proteins are found in the urine. In order to be able to assess the extent of protein excretion, the so-called albumin-creatinine quotient in the urine is determined. The concentration of albumin blood proteins in the urine is measured and related to the creatinine concentration in the urine.
If the albumin-creatinine ratio is over 30 milligrams per liter, kidney disease is present. This form of pathological protein excretion is also known as albuminuria. The diagnosis is secured by imaging methods such as Doppler ultrasound, computed tomography, magnetic resonance imaging, as well as arterio- and venography.
Older studies report that 8 to 27 percent of all renal vein thrombosis recurs. However, more recent studies refute these results. Accordingly, repeated thromboses occur rather rarely. Patients who develop renal vein thrombosis on the basis of nephrotic syndrome do not have a reduced life expectancy. In contrast, life expectancy is reduced in patients with cancer. Patients treated with warfarin instead of Marcumar have a better prognosis.
The further course of a renal vein thrombosis depends on the course of the causative factors and whether the thrombosis is treated. If left untreated, one of the most serious complications is the possibility of a pulmonary embolism. This happens when the blood clot (thrombus) breaks off in the renal vein, travels from there to the right ventricle of the heart and is then pumped into the pulmonary circulation, where a pulmonary artery is blocked.
Typically, renal vein thrombosis covers a wide range of symptoms. In some cases, the symptoms are below the threshold of perception, so that usually no treatment is given. If the thrombosis shows up with clear specific symptoms such as pain in the affected flank and bloody urine, the further course can lead to kidney failure if left untreated. However, there are also known cases in which the blood clots have spontaneously dissolved and the symptoms have improved more or less by themselves.
The extent to which the symptoms subside after spontaneous resolution of the thrombus or after a successful intervention depends on whether the kidney has already been irreversibly damaged. Treatment of the thrombus usually consists of trying to dissolve the blood clot by giving heparin. In severe cases, in which the thrombus can be located precisely, surgical removal of the clot can also be considered.
When should you go to the doctor?
Renal vein thrombosis develops slowly and does not produce clear symptoms until the late stages. A doctor must be consulted if pain occurs in the hips and back behind the lower ribs. If you notice fever, nausea and vomiting as well as blood in your urine, you should seek medical advice. If a pulmonary embolism is suspected, which is manifested by sudden chest pain and shortness of breath, the emergency doctor must be called.
People suffering from cancer, especially renal cell carcinoma and nephrotic syndromes, are among the risk patients. There is also an increased risk after surgical interventions and thromboembolism, which is why the patients must inform the doctor immediately in these cases.
Infants suffering from sepsis, cystic kidneys, or dehydration must be presented to the pediatrician if signs of renal vein thrombosis appear. Renal vein thrombosis is treated by the general practitioner or a nephrologist. The individual symptoms can be examined and treated by urologists, gynaecologists, gastroenterologists and specialists in venous diseases.
Treatment & Therapy
Surgical removal of the blood clot is possible. However, due to the possible complications, this surgical procedure is rarely performed. Treatment is usually with anticoagulants. Anticoagulants are medicines that prevent blood from clotting. They are therefore also called anticoagulants. The anticoagulants heparin and marcumar are used in renal vein thrombosis.
Heparins are polysaccharides that inhibit the coagulation cascade in the blood. The protease inhibitor antithrombin III circulates in the blood. This can inhibit activated coagulation factors such as thrombin or factor Xa. Both factors cause the blood to clot. Heparin binds to antithrombin III. As a result, it binds to the coagulation factors much more quickly and inactivates them. Therefore, heparin is used to treat thrombosis. Marcumar also has an anticoagulant effect.
It reduces the amount of coagulation factors II, VII, IX and X. With the help of heparin and marcumar, the thrombus in the renal vein should dissolve. Treatment must be continued for at least half a year. To prevent further thrombosis, lifelong treatment with the anticoagulant drugs may be necessary.
Outlook & Forecast
The prognosis of renal vein thrombosis must be based on the individual causal findings. However, it is a serious disease that can be fatal if the disease progresses unfavorably. It is a medical emergency that requires immediate action to ensure the survival of the victim.
The risk of renal vein thrombosis is significantly increased in people who have had a kidney transplant. If the transplant succeeds without further complications, recovery is possible. However, due to the health issue at hand, the affected person is bound to a lifelong medical check-up.
If the thrombosis was caused by an act of violence, there are good prospects of healing as the disease progresses. The prerequisite for this is that no other external influences take place in this region of the body. The prognosis is worse in patients diagnosed with cancer.
If this is causally responsible for the development of the thrombosis, the overall situation must be considered more closely. If the cancer can be treated successfully, the further prospects improve and an alleviation of the symptoms can be expected. In an advanced stage, however, a shortening of lifespan is to be expected.
Severe diarrhea and dehydration are also medical emergencies. If this can be treated successfully, a cure is possible.
Renal vein thrombosis can only be prevented by early treatment of the underlying disease.
Due to the quite high recurrence rate of up to 27 percent, follow-up examinations are certainly appropriate. This recurrence of renal vein thrombosis is usually due to deeper thrombosis in the leg veins, which can also show up in the renal veins. Other aftercare measures depend on the symptoms and cause of the renal vein thrombosis.
If it was based on dehydration or deficiency symptoms, these must be compensated for urgently during or after treatment. A good water intake and a diet rich in vitamins increase blood and vascular health and can accordingly restore damaged tissue. It also reduces the chance of the thrombosis reoccurring. Follow-up care in this form is particularly useful for older patients. In younger patients, renal vein thrombosis usually has other reasons.
Treatment with anticoagulants also entails follow-up care. The success of the therapy can be evaluated using imaging methods and blood tests. If surgical measures are necessary, appropriate aftercare must take place. This is usually necessary in the case of cystic kidneys or cancer.
Depending on the condition of the patient, follow-up care is also carried out on an inpatient basis. In the case of cancer in children, where the nephroblastoma in particular is often the cause, it makes sense to carry out check-ups over and over again. If the renal vein thrombosis has been treated and the underlying cause eliminated, follow-up measures are often no longer necessary.
You can do that yourself
In the case of renal vein thrombosis, the patient has few options for self-help. In most cases, there are other underlying diseases that need to be treated and treated in order for health to improve. Although the patient has hardly any measures for a physical change in the situation, he can do a lot for his vitality and well-being.
He supports his immune system with a healthy and balanced diet. This gives the organism more defenses in the fight for healing. Sufficient exercise and the continuous supply of oxygen also help to mobilize one of the forces. Being overweight or gaining a lot of weight is not recommended. The body weight should be within the recommendations of the BMI. The consumption of harmful substances such as nicotine, alcohol or other drugs should be avoided. These trigger a weakening of the patient and lead to an increase in symptoms.
With an optimistic basic attitude, the person concerned can do a lot for himself. The design of leisure activities should take place despite all adversities. This increases the motivation to live and feelings of happiness are produced. For help and support, advice can be obtained from self-help groups or internet forums from other sufferers. The mutual exchange can improve the handling of the complaints in everyday life.