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Bilateral renal vein thrombosis and pulmonary embolism secondary to membranous glomerulonephritis treated with percutaneous catheter thrombectomy and localized thrombolytic therapy.

Janda SP - Indian J Nephrol (2010)

Bottom Line: We present a case with bilateral RVT complicated by a pulmonary embolism in a patient with membranous glomerulonephritis (MGN).Venography was used for diagnosis.The patient was then anticoagulated for life with warfarin.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

ABSTRACT
Renal vein thrombosis (RVT) is a rare event but is prevalent in patients with nephrotic syndrome. Bilateral RVT is even rarer. The literature is relatively sparse in terms of the management of RVT because of its rarity and consists of a few case reports and case series. We present a case with bilateral RVT complicated by a pulmonary embolism in a patient with membranous glomerulonephritis (MGN). A 19-year-old female presented with acute flank pain and worsening renal function after a couple of weeks in hospital while being treated with diuretics for anasarca secondary to MGN. Venography was used for diagnosis. The patient underwent percutaneous catheter thrombectomy and localized thrombolysis achieving resolution of pain and improvement of renal function. The patient was then anticoagulated for life with warfarin.

No MeSH data available.


Related in: MedlinePlus

Renal venogram showing the left renal vein with a large occlusive thrombus involving the central 5 cm of the left renal vein with thrombus extending into the inferior vena cava
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Figure 0002: Renal venogram showing the left renal vein with a large occlusive thrombus involving the central 5 cm of the left renal vein with thrombus extending into the inferior vena cava

Mentions: Her renal function continued to worsen (Cr 1.76 mg/ dL) and as a result her diuretics were held and she was given IV albumin. She could not undergo the MRI because she was claustrophobic and as result, a renal venogram was ordered. On day 19, she underwent a renal venogram which revealed a large occlusive thrombus involving the central 5 cm of the left renal vein with thrombus extending into the inferior vena cava (IVC) [Figure 1]. The right renal vein also contained an occlusive or nearly occlusive thrombus in its central aspect with mild extension into the IVC [Figure 2]. Mechanical thrombolysis of the left renal vein thrombus was carried out with a wire and catheter which were eventually passed beyond the thrombus. An infusion catheter was then placed and thrombolysis with TPA was done. A 1/10 mixture of TPA (0.1 mg/ ml) was mixed and injected at 2 ml/sec for 5 seconds (0.5 mg) every 60 seconds for a total of 24.5 mg of TPA over 49 minutes. Modest improvement was obtained postthrombolytic therapy. It was decided that if renal function continued to worsen, repeat thrombolysis be done in a couple of days. Her renal function continued to worsen (Cr 2.08) and thrombolysis with TPA was performed again, this time on the right, on day 21 for total dose of 20 mg of TPA over 40 minutes.


Bilateral renal vein thrombosis and pulmonary embolism secondary to membranous glomerulonephritis treated with percutaneous catheter thrombectomy and localized thrombolytic therapy.

Janda SP - Indian J Nephrol (2010)

Renal venogram showing the left renal vein with a large occlusive thrombus involving the central 5 cm of the left renal vein with thrombus extending into the inferior vena cava
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2966982&req=5

Figure 0002: Renal venogram showing the left renal vein with a large occlusive thrombus involving the central 5 cm of the left renal vein with thrombus extending into the inferior vena cava
Mentions: Her renal function continued to worsen (Cr 1.76 mg/ dL) and as a result her diuretics were held and she was given IV albumin. She could not undergo the MRI because she was claustrophobic and as result, a renal venogram was ordered. On day 19, she underwent a renal venogram which revealed a large occlusive thrombus involving the central 5 cm of the left renal vein with thrombus extending into the inferior vena cava (IVC) [Figure 1]. The right renal vein also contained an occlusive or nearly occlusive thrombus in its central aspect with mild extension into the IVC [Figure 2]. Mechanical thrombolysis of the left renal vein thrombus was carried out with a wire and catheter which were eventually passed beyond the thrombus. An infusion catheter was then placed and thrombolysis with TPA was done. A 1/10 mixture of TPA (0.1 mg/ ml) was mixed and injected at 2 ml/sec for 5 seconds (0.5 mg) every 60 seconds for a total of 24.5 mg of TPA over 49 minutes. Modest improvement was obtained postthrombolytic therapy. It was decided that if renal function continued to worsen, repeat thrombolysis be done in a couple of days. Her renal function continued to worsen (Cr 2.08) and thrombolysis with TPA was performed again, this time on the right, on day 21 for total dose of 20 mg of TPA over 40 minutes.

Bottom Line: We present a case with bilateral RVT complicated by a pulmonary embolism in a patient with membranous glomerulonephritis (MGN).Venography was used for diagnosis.The patient was then anticoagulated for life with warfarin.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

ABSTRACT
Renal vein thrombosis (RVT) is a rare event but is prevalent in patients with nephrotic syndrome. Bilateral RVT is even rarer. The literature is relatively sparse in terms of the management of RVT because of its rarity and consists of a few case reports and case series. We present a case with bilateral RVT complicated by a pulmonary embolism in a patient with membranous glomerulonephritis (MGN). A 19-year-old female presented with acute flank pain and worsening renal function after a couple of weeks in hospital while being treated with diuretics for anasarca secondary to MGN. Venography was used for diagnosis. The patient underwent percutaneous catheter thrombectomy and localized thrombolysis achieving resolution of pain and improvement of renal function. The patient was then anticoagulated for life with warfarin.

No MeSH data available.


Related in: MedlinePlus