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Diagnosis and Treatment of Renal Vein Thrombosis

The clinical picture depends on the degree of renal vein thrombosis, the speed with which it develops, whether or not it is bilateral, and the development of effective venous collaterals (Figure 1). Thus, if the renal venous occlusion is sudden and complete, there is marked congestion, hemorrhagic infarction, and either atrophy with loss of function, or rupture, retroperitoneal hemorrhage, shock, and even death. Incomplete acute venous obstruction, on the other hand, may lead to moderate congestion and poor renal function, but if venous collateralization is adequate, normal renal function may return. This is particularly true of left renal vein thrombosis, even without treatment, because of better potential venous collateral drainage. Gradual renal vein thrombosis, while not as impressive clinically, will lead to mild congestion and reduced renal function. Accurate diagnosis will aid the clinician in efforts to improve venous collaterals, the adequacy of which will determine the degree of return of renal function. Furthermore, an understanding of this