[Prognosis of renal vein thrombosis in the adult: influence of treatment]

Abstract

The medical histories of 27 patients with renal vein thrombosis were evaluated retrospectively. Short and long term evolution as well as prognostic factors were analysed. 24 of the patients were suffering from a nephrotic syndrome, 15 from renal failure. In the 20 biopsies performed we observed: 14 cases of extramembranous glomerulonephritis, 2 cases of minimal glomerular lesions, 3 cases of segmental focal glomerulosclerosis and 1 periarteritis nodosa. The renal vein thrombosis was bilateral (18), left (7) or right (2). In 7 patients this was associated with thrombosis of the inferior vena cava. 9 patients were treated with anticoagulants alone, 9 underwent thrombectomy, 7 were treated by thrombolysis and 2 received no treatment. Within the first six months 11 patients died as a result of complications due to hemorrhaging (5), septic infection (2) or embolism (1) and 3 patients died of undetermined causes. The progression of the remaining patients was followed up over a period of 6 months to 19 years. In 12 patients, the nephrotic syndrome regressed and renal function did not deteriorate in any of the cases. The main causes for poor prognosis are the existence of initial renal failure and glomerulonephritis which is not extramembranous. Since the evolution of the glomerulopathy does not appear to be affected by extramembranous glomerulonephritis, renal vein thrombosis associated with this complication should be treated with anticoagulants alone. The risk-benefit ratio of thrombectomy leads us to conclude that this technique should be abandoned. Thrombolysis could be considered in cases where renal vein thrombosis is associated with acute renal failure.