What Is Cortical Venous Thrombosis?

Renal venous thrombosis refers to a series of pathological changes and clinical manifestations of renal vascular disease caused by thrombosis of the main renal vein and / or its branches, which cause the renal vein to be completely or partially blocked.

Basic Information

Visiting department

Nephrology

Common causes

Endothelial injury, slowed blood flow, and hypercoagulability

Common symptoms

Pain in lumbar ribs or abdomen, abnormal glomerular function, enlarged kidney on the affected side, etc.

Causes of renal venous thrombosis

Renal venous thrombosis is mainly related to vascular endothelial damage, slowed blood flow and high blood coagulation. The specific reasons are as follows.
1. In nephrotic syndrome, disorders of protein metabolism induce abnormalities in the coagulation system, fibrinolysis system, and platelet function; hyperlipidemia and insufficient effective blood volume increase blood viscosity; application of glucocorticoids leads to hypercoagulability.
2. Taking a contraceptive pill induces a hypercoagulable state.
3 Dehydration results in decreased renal blood flow.
4 Blood flow stasis caused by renal vein compression.
5. Renal vein vessel wall damage caused by trauma and tumor.
6. The application of cyclosporine to kidney transplantation can lead to hypercoagulability.

Clinical manifestations of renal venous thrombosis

Acute renal vein thrombosis often presents typical clinical manifestations: pain in the lumbar ribs or abdomen, sometimes severe, which can be accompanied by nausea, vomiting, and pain in the spine and ribs; abnormal glomerular function, and occasionally cause oliguria-type acute kidney injury; Renal enlargement on the diseased side; Common hematuria under microscope or gross eyes may cause proteinuria or exacerbation of original proteinuria; Acute renal venous thrombosis may develop fever and increase in peripheral white blood cell counts, and chronic renal venous thrombosis may sometimes cause renal tubules Dysfunction.

Renal venous thrombosis

1. Percutaneous femoral vein puncture and selective renal venography by X-ray angiography have the widest clinical application. It is found that renal venous thrombosis can be diagnosed by finding that the vascular lumen filling defect or venous branch is not developed.
2. B-ultrasound can observe changes in renal venous blood flow and changes in renal volume, suggesting renal venous thrombosis. This test has poor sensitivity and specificity in the diagnosis of renal venous thrombosis.
3 CT angiography or magnetic resonance angiography uses non-ionized iodine contrast agent for enhanced CT angiography, or gadolinium contrast agent for enhanced magnetic resonance angiography to detect renal venous thrombosis with high sensitivity and specificity. Attention should be paid to the nephrotoxicity of the contrast medium, and hydration treatment should be performed when necessary.

Renal vein thrombosis diagnosis

It can be done according to typical clinical manifestations (such as lumbar or abdominal pain, spinal and vertebral corner pain) and related examination results (such as renal vein angiography seeing vascular cavity filling defect or vein branch not developing, B-ultrasound seeing kidney enlargement, etc.) Out diagnosis.

Renal vein thrombosis treatment

1. Drug therapy (1) Anticoagulation therapy: Severe patients often develop a hypercoagulable state. Heparin or low-molecular-weight heparin can be administered subcutaneously. After the condition is stable, oral anticoagulant drugs such as warfarin are used.
(2) Antiplatelet therapy: Aspirin treatment is commonly used, and patients with peptic ulcer should be used with caution.
(3) Thrombolytic therapy: The sooner the fibrinolytic drug is applied after thrombosis, the better, and the thrombolytic effect is the best within 6 hours. However, the clinical symptoms of renal vein thrombosis are not obvious, and it is difficult to judge the time of thrombosis. Some scholars have suggested that once renal vein angiography confirms renal vein thrombosis, try 1 course to several courses of urokinase treatment.
2. Interventional therapy Interventional therapy includes catheterized local drug thrombolysis and mechanical thrombectomy. It is mainly used for patients with acute renal venous thrombosis with rapid decline of renal function. If applied in time, it can quickly improve renal function and reduce mortality. Anticoagulant therapy should be supplemented before and after thrombectomy to prevent thrombosis from forming. If the mechanical resection is not complete and there is still a thrombus remaining, the catheter can be retained after the resection to perform local drug thrombolysis to remove the residual thrombus. If renal vein stenosis occurs after mechanical resection of the thrombus, interventional techniques can be used to perform balloon dilation Operation, place the stent.

Renal venous thrombosis prognosis

After timely treatment, with the recanalization of blood vessels and / or collateral circulation, renal function can be restored to varying degrees. Renal venous thrombosis is the biggest harm is thrombolysis and embolism of pulmonary arteries, leading to pulmonary embolism, which can be life-threatening in severe cases.