Lethal Renal Venous Thrombosis Complicating Dehydration in Infancy

A 3-month-old boy presented to hospital in cardiac arrest, dehydrated, with a blood sodium of 158.4 mmol/L. He had been febrile, not feeding normally and refusing fluids. Despite attempts at resuscitation with rehydration, he was declared dead. At autopsy, the kidneys were uniformly enlarged with thrombi within intraparenchymal tributaries of the renal veins bilaterally. Death was due to bilateral renal venous system thrombosis with hypernatremic dehydration. It is likely that the dehydration resulted both from increased requirements for fluid due to fever and from inadequate oral intake. Lethal renal venous thrombosis is a rare multifactorial condition that should be suspected in all infants with histories of hypernatremic dehydration with hypotension. Although there may be no obvious renal vein thrombosis at the time of dissection, microscopy may reveal intraparenchymal venous thromboses. As inherited prothrombotic states are associated with renal venous thrombosis, hematologic evaluation of immediate family members would be in order.