Researches into the connection existing between an unnatural degree of compression of the blood contained in the renal vessels, and the presence of certain abnormal matters in the urine

Renal vein occlusion: a review

PURPOSE

The different etiologies of renal occlusion are reviewed. A special category, division of the left renal vein in abdominal aortic surgery, is also discussed in the review.

MATERIALS AND METHODS

The various diagnostic modalities used in cases of renal vein occlusion include excretory urography, ultrasound, nuclear scan, angiography, venography, computerized tomography and magnetic resonance imaging. The main goals of therapy in this condition should be conserve renal parenchyma and to protect renal function.

RESULTS

The principal mode of treatment is medical and includes correction fluid and eletrocyte imbalance, dialysis, antihypertensive drugs, anticoagulation and in certain cases thrombolysis.

CONCLUSIONS

Renal vein occlusion in adults is usually a result of the vein thrombosis which is frequently associated with the nephrotic syndrome. The anatomy of renal vascularization is of primary importance in understanding its pathophysiological responses and the clinical and diagnostic presentation of patients with this condition. The reaction of the kidney to its vein occlusion is determined by the balance between the acuteness of the disease, extent of the development of collateral circulation, involvement of 1 or both kidneys and the origin of the underlying disease. Renal vein occlusion is generally a complication of some other condition but may also be a primary disease.

Selective renal venography in patients with primary renal disease and the nephrotic syndrome

Fifteen patients with primary renal disease and renal vein thrombosis who presented with the nephrotic syndrome were investigated venographically. In 46% of the patients the cavogram was normal. Selective renal venography is necessary in such patients because the course of patients with renal vein thrombosis and membranous glomerulonephritis is identical to that of patients with membranous glomerulonephritis alone. Eighty per cent of our patients had membranous glomerulonephritis; renal vein thrombosis is now thought to be secondary to this disease.

Renal vein thrombosis

The manifestations, clinical course and treatment of 14 patients with non-malignant renal vein thrombosis are described. Most patients (10 of 14) had generalized vague illness and nephrotic syndrome but 4 were initially seen with acute symptoms of flank pain, hematuria or hypertension. Renal vein thrombosis affected young men 2.5 times more often than women and occurred on the left side 2.6 times more commonly than on the right or both sides. Red blood cell casts in the urinary sediment, heavy proteinuria and hypoalbuminemia were useful indicators of the disease. Excretory urographic signs were suggestive of renal vein thrombosis in all patients and these were corroborated by angiographic studies. Systemic anticoagulation with or without a renal failure program and diuretics, or simply a combination of the last 2 modalities, was used in 9 patients. In 2 of the 9 patients who were unresponsive the adjuvant use of cyclophosphamide and steroids effected a cure. The remaining 5 patients underwent nephrectomy or thrombectomy. All 14 patients were followed for 1 to 7 years (mean 1.6 years). Ten patients were cured or improved, 1 patient was unchanged, and in the remaining 3 patients the condition deteriorated and they subsequently required a renal allograft. The rationale for various forms of treatment is discussed.

The protean manifestations of renal vein thrombosis in the adult

We reviewed 8 cases of renal vein thrombosis, 4 of which were detected at autopsy, 1 by laparotomy and the remaining 3 by venography. In 4 cases malignancy also was found and in 2 membranous glomerulonephritis was noted. In 1 patient the thrombosis occurred in a solitary kidney, while it was bilateral in 3. The 4 patients in whom the diagnosis was made during life were treated with anticoagulants alone and 3 are alive with stable renal function 3, 4 and 7 1/2 years after diagnosis.