Diseases

Renal venous thrombosis - causes, symptoms and treatment


Renal dysfunction due to blood clot in the renal vein

With renal vein thrombosis, there is a vascular occlusion in the renal vein, caused by a blood clot that has formed locally or has been carried in the bloodstream. The impaired blood transport or complete blood congestion can trigger violent symptoms in acute cases. Most of the time, however, the disease begins only gradually and manifests itself with no or only slight complaints. For a successful treatment, it is not only important to dissolve or remove the thrombosis, but also to determine the triggers and underlying underlying diseases.

A brief overview

The following overview provides quick information on the most important facts about kidney vein thrombosis. Detailed information on the clinical picture can be found in the article below.

  • definition: One- or both-sided renal vein thrombosis is a circulatory disease due to a blood clot in the renal vein. The resulting vascular occlusion leads to impaired blood flow and kidney functions.
  • Symptoms: In most cases, the creeping, chronic disease often expresses itself with only mild symptoms or is initially free of symptoms. However, in the advanced stage or in an acute onset, there may be very painful flank pain and other symptoms of kidney dysfunction, such as blood in the urine.
  • causes: In addition to pathological changes in the kidney or injuries to the kidney tissue, various underlying diseases are the main triggers for venous thrombosis. A nephrotic syndrome is particularly common in adults, for example due to glomerulonephritis or a blood clotting disorder (hypercoagulability).
  • diagnosis: Different imaging methods can make thrombosis visible. X-ray examinations (venography), CT and MRI angiography as well as ultrasound (Doppler and duplex sonography) are used.
  • treatment: The primary cause is treatment of the cause, supplemented by medication to prevent or dissolve a vascular plug and, if necessary, to relieve pain. The therapy usually lasts up to a year and can also become necessary for life. Surgical removal of the blood clot is rarely required.
  • Naturopathic treatment: Supportive methods from naturopathy such as phytotherapy can be used to prevent thrombosis. A healthy diet with sufficient omega-3 fatty acids, sufficient physical activity and sufficient liquid generally has a health-promoting effect and lowers the risk of thrombosis.

Definition

Renal vein thrombosis (NVT) is one of the diseases of the circulatory system in which there is unilateral or bilateral thrombosis or embolism of the paired renal vein (vena ranalis). A blood clot in the renal vein results in partial or complete vascular occlusion with impaired blood transport.

In general, this type of thrombosis is rarely diagnosed. There is often evidence in connection with certain underlying diseases, such as nephrotic syndrome or cancer. The acute form is much less common than chronic and gradual renal vein thrombosis. The consequences can be kidney dysfunction, kidney damage or a kidney infarction.

The disease can occur at any age, but mostly adults and the elderly (over 70 years) fall ill. A slightly increased occurrence is also found up to around the age of 20. If the disease occurs in newborns and children, this is usually the result of dehydration.

Symptoms

In most cases, the disease begins insidiously and complaints only gradually or even completely disappear. Renal vein thrombosis is often only recognized when further sequelae are added. This can lead to a partial detachment of the blood clot, which is carried along with the blood stream and then clogs a vessel elsewhere, such as in the lungs (pulmonary embolism). The following complaints are sudden chest pain and shortness of breath.

Typical symptoms that can occur with a blocked renal vein and renal dysfunction are:

  • Flank pain,
  • Back pain (in the area of ​​the lower ribs) and hip pain,
  • low urination (oliguria),
  • Macrohematuria (blood in the urine) and proteinuria (protein in the urine),
  • Edema (water retention),
  • Nausea and vomiting,
  • Fever.

These signs mainly occur with acute kidney obstruction and are often accompanied by severe pain. The sudden occlusion of the renal veins causes blood congestion in the kidney, which usually causes severe renal colic and flank pain. Children are primarily affected by the acute form.

In adults, the much more frequent partial occlusion leads less to cramp-like symptoms than to permanent pain in the flanks. However, even an incomplete occlusion, if left untreated, leads to the death of the kidney tissue with loss of function and corresponding symptoms.

Possible complaints also depend on the causes of the disease. For example, if there is kidney cancer, weight loss usually occurs in connection with the cancer.

Causes

Renal vein thrombosis usually occurs as a result of another illness or due to previous trauma. These include primary triggers such as kidney injuries, kidney cysts, kidney surgery or, not infrequently, kidney tumors. Other diseases are secondary causes (outside the kidney) and include various metabolic and autoimmune diseases.

In most cases, thrombosis in adults is caused by a nephrotic syndrome, which often develops as a result of glomerulonephritis. This is a symptom complex that includes increased protein excretion in the urine (proteinuria), a low protein concentration in the blood, high blood lipid levels (hyperlipoproteinemia) and edema formation. These are clear signs of inflammation of the kidneys with damage to the kidney corpuscles and their vascular balls (glomerulus).

But blood coagulation disorders (hypercoagulability) can also lead to nephrotic syndrome and thus to venous thrombosis in the kidney, because increased coagulability of the blood causes an increased risk of thrombus formation (thrombophilia). Furthermore, other diseases such as diabetes mellitus can lead to a nephrotic syndrome (diabetic nephropathy).

In children, internal dehydration due to insufficient fluid intake or massive fluid loss, for example in the case of diarrhea and vomiting, is often the reason for the occurrence of the disease.

Sometimes it is not possible to clearly determine the underlying causes. In this context one speaks of an idiopathic renal vein thrombosis.

Diagnosis

X-ray examination of the renal veins (venography) is a proven and precise method for determining a renal vein thrombosis. Using a contrast agent, very precise results are obtained, but the method is associated with the risk of a blood clot becoming detached and causing an embolism. In order to avoid this complication, other imaging methods are increasingly being used today. These include angiography using computed tomography (CT) or magnetic resonance imaging (MRI) and Doppler sonography. Enlarged kidneys and blocked blood flow can be seen on ultrasound, but the results may be incorrect.

If these diagnostic methods are not sufficient and the causes of the symptoms that have arisen are unknown, further specific examinations should be carried out.

Treatment

The primary focus is on treating the cause of a confirmed underlying disease. In addition, medication is often used to dissolve the vascular graft (especially in the acute case) or to prevent its formation. Preparations for clot dissolution (fibrinolytics) and anticoagulants (anticoagulants) such as heparin and coumarin are used.

The duration of therapy usually extends over a period of six to twelve months. However, permanent medication can also occur in those affected, among other things to prevent repeated occurrence. However, the therapy of the underlying disease is also particularly important for prevention.

In rare cases, a thrombectomy is required, in which a blood clot is removed using a catheter or a surgical procedure. If severe pain occurs, pain relievers should also be prescribed.

Naturopathic treatment

A thrombosis is basically a dangerous disease and always requires conventional medical treatment. Naturopathy can help with prevention, especially with superficial venous thrombosis. In the case of a (deep-seated) renal vein thrombosis, naturopathic treatments can be useful if, for example, there is a genetic or acquired tendency to thrombosis (thrombophilia).

Various home remedies, moderate exercise, and some naturopathic treatments have been shown to be effective in preventing clot build-up. In principle, a healthy diet with enough omega-3 fatty acids and an adequate hydration should be observed. Drinking too little causes thicker blood and a higher risk of thrombosis, whereas a lot of fluid stimulates the circulation.

Phytotherapy is often used for venous diseases. The internal use of rutin, which occurs in various medicinal plants, is recognized. Buckwheat is often used here. Rutin helps strengthen the blood vessel walls and capillary walls. In addition to thrombosis and varicose veins, areas of application include diabetes mellitus and high blood pressure. (jvs, cs)

For further reading:
Kidney congestion
Kidney problems
Kidney pain

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dr. rer. nat. Corinna Schultheis

Swell:

  • Merck and Co., Inc .: renal vein thrombosis (accessed: June 24, 2019), msdmanuals.com
  • Wysokinski, Waldemar E. / Gosk-Bierska, Izabela / Greene, Eddie L. / and others: Clinical Characteristics and Long-term Follow-up of Patients With Renal Vein Thrombosis, American Journal of Kidney Diseases, 2007, DOI: https: // doi.org/10.1053/j.ajkd.2007.10.030, ajkd.org
  • Pschyrembel online: renal vein thrombosis (accessed: June 24, 2019), pschyrembel.de
  • Mayo Clinic: Nephrotic syndrome (accessed: June 24, 2019), mayoclinic.org
  • Amboss GmbH: Nephrotic Syndrome (accessed: June 24, 2019), amboss.com

ICD codes for this disease: I82ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.


Video: Deep Venous Thrombosis Treatment at Stanford Hospital (November 2021).