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Ndoudi Likoho B, Berthaud R, Dossier C, Delbet JD, Boyer O, Baudouin V, Alison M, Biran V, Hurtaud MF, Hogan J, Kwon T, Couderc A. Renal vein thrombosis in neonates: a case series of diagnosis, treatment and childhood kidney function follow-up. Pediatr Nephrol 2023; 38:3055-3063. [PMID: 36988695 DOI: 10.1007/s00467-023-05918-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Neonatal renal vein thrombosis (NRVT) is a rare condition with little data available. METHODS We retrospectively analyzed newborns diagnosed with NRVT admitted to 3 pediatric nephrology units in Paris from 2005 to 2020. RESULTS Twenty-seven patients were analyzed (male = 59%). The median age at diagnosis was 2.5 days (1 - 4.5). Diagnosis was suspected based on at least one of the three cardinal signs of renal vein thrombosis in 93%: flank mass (67%), hematuria (67%) and thrombocytopenia (70%). In all patients, diagnosis was confirmed by ultrasound. All patients had at least one known perinatal risk factor. A prothrombotic risk factor was found in 13 patients (48%). NRVT was unilateral in 70%, involving the left renal vein in 58%. Among 25 treated patients, 19 (76%) received low molecular weight heparin (LMWH) as initial therapy, 2 (8%) received unfractionated heparin and 4 (16%) received fibrinolysis. Median duration of treatment was 8 weeks (4 - 12). Bleeding occurred significantly more often with fibrinolysis than with LMWH/supportive therapy (3 of 4: 75% vs 0 of 4: 0%, p = 0.05). Clot resolution in patients treated with fibrinolysis did not differ significantly from those treated with LMWH/supportive therapy. After a median follow-up of 5.7 years (3 years - 9.9 years), pathological kidney features were observed in 73% of the patients (19 of 26), kidney atrophy in 18 (69%), hypertension in 2 (8%), chronic kidney disease (CKD) in 1 (4%) and proteinuria in 2 (8%). CONCLUSIONS NRVT remains a challenging condition, which still requires further study because of its associated morbidity. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Bellaure Ndoudi Likoho
- Department of Pediatric Nephrology, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France.
| | - Romain Berthaud
- Department of Pediatric Nephrology, Necker-Enfants-Malades University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France
| | - Claire Dossier
- Department of Pediatric Nephrology, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France
| | - Jean-Daniel Delbet
- Department of Pediatric Nephrology, Trousseau University Hospital, Assistance Publique - Hôpitaux de Paris, and Sorbonne University, Paris, France
| | - Olivia Boyer
- Department of Pediatric Nephrology, Necker-Enfants-Malades University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France
| | - Véronique Baudouin
- Department of Pediatric Nephrology, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France
| | - Marianne Alison
- Department of Pediatric Radiology, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France
| | - Valérie Biran
- Neonatal Intensive Care Unit, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France
| | - Marie-Françoise Hurtaud
- Biological Hematology Department, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France
| | - Julien Hogan
- Department of Pediatric Nephrology, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France
| | - Theresa Kwon
- Department of Pediatric Nephrology, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France
| | - Anne Couderc
- Department of Pediatric Nephrology, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France
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