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Renal venous thrombosis in infancy: long-term follow-up
H Mocan1, T J Beattie, A V Murphy
1Renal Unit, Royal Hospital for Sick Children, Yorkhill, Glasgow, Scotland, UK.
Insights
Neonatal renal venous thrombosis (RVT) can lead to long-term complications. Follow-up of 16 children revealed persistent renal abnormalities and hypertension in some, impacting overall health.
Area of Science:
- Pediatric Nephrology
- Neonatal Medicine
- Vascular Biology
Background:
- Renal venous thrombosis (RVT) is a serious condition in neonates and infants.
- Early diagnosis and management are crucial for patient outcomes.
Purpose of the Study:
- To evaluate the long-term sequelae of neonatal renal venous thrombosis.
- To assess renal function, blood pressure, and developmental outcomes in affected children.
Main Methods:
- Longitudinal follow-up of 16 children diagnosed with RVT in the neonatal period or early infancy.
- Assessment included renal function tests, blood pressure monitoring, urinalysis, renal imaging, and developmental evaluations.
- Follow-up duration ranged from 29 months to 16 years.
Main Results:
- All 16 patients survived the acute illness; one died later from an unrelated cause.
- At follow-up, 11 patients had normal renal function, while 5 developed hypertension (2 responsive to nephrectomy).
- Subnormal urinary concentrating capacity was noted in 7/15 patients, and renal imaging revealed abnormalities in 12/14 patients.
Conclusions:
- Neonatal renal venous thrombosis can result in significant long-term renal abnormalities and hypertension.
- While many children maintain normal renal function, a substantial proportion experience lasting renal damage and vascular complications.
- Long-term monitoring is essential for children with a history of neonatal RVT to manage potential sequelae.
Abstract:
Sixteen children (11 male, 5 female) who developed renal venous thrombosis in the neonatal period or early infancy have been followed for periods varying from 29 months to 16 years (median 12 years) after initial diagnosis. Twelve patients presented with a hyperosmolar state, and in 4 the illness was preceded by severe birth asphyxia. The diagnosis was based on the findings of clinical and/or radiological renal enlargement (15 cases), haematuria (16 cases) and elevation in plasma urea (16 cases). Thrombocytopenia (13 cases), red cell fragmentation (13 cases) and oliguria (13 cases) were frequent associated findings. All 16 patients survived the acute illness, 1 patient died 3 years later from an unrelated event. On follow-up evaluation, 11 patients have normal renal function (glomerular filtration rate greater than 80 ml/min per 1.73 m2), 5 developed hypertension, 2 of whom responded to unilateral nephrectomy. Urinary concentrating capacity was subnormal (less than 800 mosmol/kg) in 7 of the 15 cases studied. Follow-up renal imaging studies were undertaken in 14 patients, and the imaging procedure was normal in only 2 of these. Of the remainder, 8 showed unilateral abnormality and 4 bilateral abnormality. Intellectual development was normal in 12 patients, mildly impaired in 1, and severely impaired in 3.