Bilateral Renal Vein Thrombosis

Abstract

The diagnosis of renal vein thrombosis is difficult to make during life and there are few reports of patients successfully diagnosed and treated. In this paper, observations are described on a single patient with bilateral renal vein thrombosis, proteinuria and severe oliguria. The proteinuria was massive for a short period of time, reaching a maximum concentration of 52 g/liter. The diagnosis was proven by demonstrating an increase in size of the 2 kidneys, by inferior vena cavagram and renal venogram, and by percutaneous renal biopsy. The report is unusual in that treatment with heparin was begun within hours of the occurrence of a major episode of occlusion of the renal vein, and in that there was subsequently a complete return to normal of all aspects of renal function, including the disappearance of proteinuria. The sequential changes in renal function which occurred are graphically illustrated by serial renogram studies. Three serial renal biopsies were studied by both light and electronmicroscopy. Initially, the abnormal findings included mild thickening of the capillary basement membrane, margination of poly-morphonuclear leukocytes in the glomerular capillaries, and moderate interstitial edema. The sequential observations made by electron-microscopy appear to illustrate graphically some aspects of the patho-physiology of protein transport through the glomerular capillary wall. When the third biopsy was made, most of the abnormal histologic and electronmicroscopic findings had disappeared.