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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 1994  |  Volume : 5  |  Issue : 4  |  Page : 498-499
Renal vein thrombosis and refractory nephrotic state

Zhong Shan Hospital, Shanghai Medical University, Shanghai, People's Republic of China, China

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How to cite this article:
Wu ZL, Zhou KR, Liao Lt. Renal vein thrombosis and refractory nephrotic state. Saudi J Kidney Dis Transpl 1994;5:498-9

How to cite this URL:
Wu ZL, Zhou KR, Liao Lt. Renal vein thrombosis and refractory nephrotic state. Saudi J Kidney Dis Transpl [serial online] 1994 [cited 2020 Mar 31];5:498-9. Available from: http://www.sjkdt.org/text.asp?1994/5/4/498/41142
Nephrotic syndrome is associated with a hypercoaguable state [1] . Thrombosis of the renal vein(s) is one of the major manifestations of this complication. The reported overall incidence of renal vein thrombosis is 35% while that of extra-renal thrombosis is 20% [2],[3],[4] . It is important to identify and treat this complication early since its presence makes the nephrotic syndrome refractory to treatment.

We studied 60 patients with refractory nephrotic syndrome. There were 24 males and 36 females in the study group with a mean age of 34.4 years. All patients had previously undergone renal biopsy. The histological diagnoses in these patients are given in [Table 1]. Baseline coagulation parameters such as blood fibrinogen, anti-thrombin III (AT III), factor VIII related antigen (VIII Rag) and fibrin degradation products (FDP) were measured. Other parameters monitored included renal functions and urinary protein excretion.

In view of their refractory nephrotic state, all these patients were subjected to CT scan of the abdomen to look for renal vein thrombosis (RVT). Twelve of these patients had evidence of RVT which was confirmed by selective renal venography. Renal vein thrombosis was bilateral in three patients, involved the left renal vein in five, left renal vein and inferior vena cava in three and right renal vein and inferior vena cava in one patient. Results of blood fibrinogen, AT III, factor VIII Rag and FDP in the patients with RVT are listed in [Table 2]. All the nephritic patients with RVT had hypercoaguable state. The basic glomerular pathology in these patients is given in [Table 3].

The prevalence of RVT in our study patients was 20%. This is slightly lower than what has been reported by Llach et al [4] . The utility of CT scan as a diagnostic screening procedure is demonstrated in our study. We had no false positive results. This is all the more important when we consider the fact that CT scan is non-invasive and renal venography is known to be associated with morbidity including dislodgement of the clot. Another interesting finding was that none of the patients had any focal manifestations suggestive of RVT. Similar findings have been reported by other authors as well [4],[5],[6] .

In conclusion, RVT has to be suspected in all patients with refractory nephrotic syndrome. CT scan is a reliable non­invasive tool to confirm this diagnosis.

   References Top

1.Rayer PFO. Traite des Maladies des reins et des alterations de la secretion urinaire. Paris, J-B Bailliere et Fils, 1840;2:590-93.  Back to cited text no. 1    
2.Llach F. Nephrotic syndrome: hypercoagulability, renal vein thrombosis and other thromboembolic complications. In: Brenner BM, Stein JH (eds). The nephrotic syndrome. New York, Churchill Livingstone 1982;121­44.  Back to cited text no. 2    
3.Llach F. Renal vein thrombosis and the nephritic syndrome, (chap 5). In; Llach F (ed). Renal Vein Thrombosis. New York, Futura Publishing Co., 1983;130-52.  Back to cited text no. 3    
4.Llach F, Koffler A, Finck E, Massry SG. On the incidence of renal vein thrombosis in the nephritic syndrome. Arch Intern Med 1977;137:333-6.  Back to cited text no. 4  [PUBMED]  
5.Rosenmann E, Pollak VE, Pirani CL. Renal vein thrombosis in the adult: a clinical and pathological study based on renal biopsies. Medicine Baltimore 1968;47:269-335.  Back to cited text no. 5  [PUBMED]  
6.Llach F, Papper S, Massry SG. The clinical spectrum of renal vein thrombosis: acute and chronic. Am J Med 1980;69:819-27.  Back to cited text no. 6  [PUBMED]  

Correspondence Address:
Zhao-Long Wu
Zhong Shan Hospital, Shanghai Medical University, Shanghai 200032, People's Republic of China
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PMID: 18583779

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  [Table 1], [Table 2], [Table 3]


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