Asynchronous bilateral renal venous thrombosis with subsequent development of cystic kidneys

To discuss a case of asynchronous bilateral renal venous thrombosis with a review of current literature.

A premature fraternal twin male was delivered via Cesarean section to a mother with a history of pre-eclampsia. He was initially diagnosed with a left renal venous thrombosis (RVT) but subsequently developed right RVT. Only intravenous fluids and supportive care were provided. Anticoagulation was withheld because of MRI findings of multiple areas of intracerebral bleeding. His serum creatinine concentration stabilized at 0.7 mg/dL, but follow-up renal ultrasound studies showed bilateral anechoic corticomedullary cysts. He also developed hypertension.

Renal venous thrombosis usually occurs in neonates. Multiple clinical conditions are associated with RVT, two of which exist in this case. Recent work has focused on genetic prothrombotic risk factors, one of which our patient exhibits. Controversy exists over management, i.e. whether or not to initiate anticoagulation or antithrombotic therapy to decrease the development of renal atrophy, renal failure and hypertension.

This unusual case of asynchronous bilateral renal venous thrombosis recovered in the short term without antithrombotic therapy. Substantial insult early in life is reflected in the progressive worsening of his renal function, ultrasound findings and hypertension, highlighting the need for long-term vigilant observation of these patients.