The renal vein thrombosis is the thrombotic occlusion of one or both main renal vein, which leads to acute renal failure or chronic kidney disease. Common causes include nephrotic syndrome, primary Hyperkoagulabilitätsstörungen, malignant kidney tumors, extrinsic compression, injuries and rare inflammatory bowel diseases. It can be symptoms of kidney failure and sometimes nausea, vomiting, flank pain, hematuria, observe decreased urine output or systemic manifestations of venous thromboembolism. The diagnosis is made by CT, magnetic resonance angiography or Kavographie. During treatment, the prognosis is generally favorable. The therapy consists of the administration of anticoagulants, the support of renal function and treatment of the underlying disorder. Some patients require a thrombectomy or nephrectomy.

The renal vein thrombosis is the thrombotic occlusion of one or both main renal vein, which leads to acute renal failure or chronic kidney disease. Common causes include nephrotic syndrome, primary Hyperkoagulabilitätsstörungen, malignant kidney tumors, extrinsic compression, injuries and rare inflammatory bowel diseases. It can be symptoms of kidney failure and sometimes nausea, vomiting, flank pain, hematuria, observe decreased urine output or systemic manifestations of venous thromboembolism. The diagnosis is made by CT, magnetic resonance angiography or Kavographie. During treatment, the prognosis is generally favorable. The therapy consists of the administration of anticoagulants, the support of renal function and treatment of the underlying disorder. Some patients require a thrombectomy or nephrectomy. The etiology of renal vein thrombosis is usually through a local or systemic hypercoagulable state due to a nephrotic syndrome with membranous nephropathy caused (most), minimal-change disease or membranoproliferative glomerulonephritis. The risk of thrombosis due to nephrotic syndrome appears to be proportional to the severity of hypoalbuminemia. An overly aggressive diuresis or prolonged high-dose corticosteroid therapy may contribute to thrombosis of renal vein in patients with these disorders. Other causes include allograft rejection amyloidosis Diabetic nephropathy estrogen therapy pregnancy Primary Hyperkoagulabilitäts diseases (eg. As antithrombin III deficiency, protein C or S deficiency, factor V Leiden mutation, prothrombin G20210A- mutations) Renal vasculitis Sichelzellnephropathie SLE rarer causes result from a decreased blood flow in the renal veins, z. B. by malignant renal tumors that spread to the renal vein (typical of renal cell carcinoma), compression of the renal vein or inferior vena cava from the outside (cava inferior about by vascular anomalies, tumor, retroperitoneal diseases, ligature of the vena, aortic aneurysm) or also by taking oral contraceptives, trauma, dehydration, or rarely, thrombophlebitis migrans or cocaine abuse. Symptoms and complaints Typically, the beginning of renal impairment is insidious. However, this may also use acute and caused by a renal infarction with nausea, vomiting, flank pain, hematuria and reduced urine output. If the cause is a Hyperkoagulabilitätsstörung, signs of venous thromboembolic disorder (z. B. deep vein thrombosis, pulmonary embolism) may be present. If the cause of a renal carcinoma, are its symptoms (hematuria, weight loss) in the foreground. Vascular Diagnostic imaging A renal vein thrombosis should be considered in patients with renal infarction or unexplained deterioration of renal function into account, especially in patients with nephrotic syndrome or other risk factors. The traditional diagnostic method of choice and the standard of the venography inferior vena cava. This test is diagnostic, but it can be mobilized blood clots. Because of the risks of conventional magnetic resonance venography venography and Doppler sonography are increasingly being used. A magnetic resonance venography can be performed when the GFR is> 30 ml / min. Doppler sonography detected sometimes a renal vein thrombosis but has false-positive and false-negative results in a high degree. A disengagement of the ureter through dilated collateral veins is a characteristic finding in some chronic cases. CT angiography provides good detail recognition with high sensitivity and specificity and is fast but requires the gift of an X-ray contrast agent, which may be nephrotoxic. Serum electrolytes and urinalysis are performed and confirm a deterioration of renal function. There is often a microscopic hematuria. Proteinuria can be in the nephrotic range. If no cause can be seen testing should be initiated in Hyperkoagulabilitätsstörungen (Thrombotic diseases at a glance). The kidney biopsy is nonspecific but may uncover a co-existing kidney damage. Forecast Fatal outcomes is rare and is usually with complications such as pulmonary embolism, nephrotic syndrome or a malignant tumor in context. Therapy Treatment of the underlying disease. Anticoagulation Sometimes percutaneous catheter-guided thrombolysis or thrombectomy The cause should be treated. Among the therapeutic options for renal vein thrombosis include anticoagulation with heparin, thrombolysis and catheter-guided or surgical thrombectomy. The long-term anticoagulation with low molecular weight heparin or oral warfarin should be initiated immediately if any invasive intervention is planned. The anticoagulation reduces the risk of new thrombi recanalization of vessels promotes existing clots and improves kidney function. Anticoagulation should be continued for at least 6-12 months and maintained on duration, if a Hyperkoagulabilitätsstörung (z. B. persistent nephrotic syndrome) is present. The use of a percutaneous catheter thrombectomy or thrombolysis is currently recommended surgical thrombectomy is rarely used, but should be considered in patients with acute bilateral renal vein thrombosis and acute renal failure that can not be treated with percutaneous catheter thrombectomy and / or thrombolysis. Nephrectomy is performed only with full infarction or renal tumors. Key points The most common cause of renal vein thrombosis is nephrotic syndrome with membranous nephropathy. Pull a renal vein thrombosis in patients with renal infarction or unexplained deterioration of renal function into account, particularly those with nephrotic syndrome or other risk factors. Confirm the diagnosis with angiography, usually Magnetresonanzphlebographie (if GFR> 30 ml / min) or Doppler sonography. Treat the underlying condition and initiate anticoagulation, thrombolysis or thrombectomy.

Health Life Media Team

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