Renal Vein Thrombosis

Covert 2

Step 1: View clinicals

A 46-year-old woman presents with left-sided flank pain and gross hematuria for one week. The pain is not relieved by postural changes or acetaminophen. There is no history of dysuria, urgency, or frequency. She has two children, and is presently 30 days post-partum after a full-term pregnancy that culminated in an uncomplicated, spontaneous vaginal delivery. Her medical history is notable for type 2 diabetes mellitus which is well controlled on metformin. Her surgical and family histories are unremarkable.


Step 2: Order all relevant investigations

Urinalysis

pH: 5.0 (4.5 - 8) RBC: field full/hpf (<2) WBC: 0-1/hpf (0 - 5) Cell casts: none Crystals: none seen Microorganisms: none seen Leukocyte Esterase: negative Nitrite: negative

Ultrasound abdomen

The ultrasound scan shows discrete dilatation of the pyelocalyceal cavities and slight enlargement of the left kidney. There is no evidence of urinary tract obstruction. The right kidney appears normal.

Renal function tests

Blood Urea: 14 mg/dL (7-20) Serum Creatinine: 0.8 mg/dL (0.6-1.2)

Contrast CT abdomen

The contrast CT study reveals an ectatic left renal vein with a large, hypodense thrombus extending from the segmental renal veins to the inferior vena cava. There is no evidence of urinary tract dilatation or tumoral lesions.


Step 3: Select appropriate management

Radical nephrectomy
Anticoagulation
Ciprofloxacin
Extracorporeal shock wave lithotripsy


Score: ★★☆