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Renal venous thrombosis in infancy.
J Wiggelinkhuizen1, K Oleszczuk-Raszke, F O Nagel
1Department of Paediatrics, University of Cape Town.
Summary
Renal venous thrombosis (RVT) in infants is diagnosed via enlarged kidneys, hematuria, and low platelets. Ultrasound confirms diagnosis, with supportive care and heparinization for severe cases improving survival rates.
Area of Science:
- Pediatric Nephrology
- Neonatal Thrombosis
- Vascular Medicine
Background:
- Renal venous thrombosis (RVT) in infants is linked to decreased renal blood flow and hypercoagulability.
- Clinical diagnosis involves enlarged kidneys, hematuria, and thrombocytopenia in at-risk infants.
Observation:
- Ultrasonography is the preferred diagnostic imaging, superseding invasive methods like excretory urography and venography.
- Radionuclide studies effectively document renal function impairment.
Findings:
- Supportive treatment with heparinization is indicated for severe bilateral RVT and inferior vena cava thrombosis.
- Thrombectomy and fibrinolytic therapy have limited roles in infantile RVT.
- Improved survival rates are noted in recent years.
Implications:
- Severe venous infarction can cause renal atrophy, potentially misdiagnosed as congenital renal hypoplasia.
- Hyperreninemic hypertension, a complication of RVT, is treatable with nephrectomy.