BILATERAL RENAL VEIN THROMBOSIS AND THE NEPHROTIC SYNDROME

Abstract

Gradual thrombotic occlusion of the renal veins may be manifested by the nephrotic syndrome. The entity is characterized by anasarca, proteinuria, hypoproteinemia and hyperlipemia, in a patient who usually has overt evidence of thrombotic phenomena. At autopsy the renal veins are occluded by pre-mortem thrombi and the kidneys are moderately enlarged, showing interstitial edema and fibrosis and tubular changes. The literature of this entity is reviewed in detail. The 7th case of such a syndrome is presented and the outstanding clinical and laboratory findings, including kidney biopsy described. A comparison of the histology of the kidney biopsy and the histological findings at autopsy 3 months later revealed a marked increase in interstitial fibrosis and inflammatory cell infiltration in the latter. Various observations should heighten the suspicion of bilateral renal vein thrombosis as an etiological factor in the nephrotic syndrome; 1st, the development of the nephrotic syndrome in an adult with no previous history or findings of renal disease; 2d, the occurrence of nephrosis associated with any intravascular thrombotic or embolic phenomena or unrelated disease which through stasis or inflammation may predispose to thrombosis; 3d, a progressive downhill course without the remissions common to nephrosis of other etiologies. Percutaneous renal biopsy may rule out other etiolgies of the nephrotic syndrome. Venography may be considered in establishing thrombosis of the inferior vena cava and renal veins. Diagnosis of renal vein thrombosis is of more than academic value, since with the use of anticoagulants and/or surgery the progression of the disease may be altered or perhaps even completely interrupted.