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Renal venous thrombosis in children: changes in management
Insights
Renal venous thrombosis primarily impacts newborns, presenting with kidney enlargement and blood in urine. Treatment is supportive, with surgery reserved for rare bilateral cases.
Area of Science:
- Pediatric Nephrology
- Vascular Medicine
Background:
- Renal venous thrombosis (RVT) is a significant vascular condition affecting newborns.
- It is associated with various perinatal risk factors including maternal diabetes and perinatal distress.
- RVT can manifest unilaterally or bilaterally, impacting kidney health.
Purpose of the Study:
- To summarize the etiology, clinical presentation, diagnostic methods, and management of renal venous thrombosis in neonates.
- To highlight the potential long-term complications of this condition.
Main Methods:
- Review of clinical signs such as gross hematuria, palpable kidney enlargement, and thrombocytopenia.
- Diagnostic evaluation utilizing ultrasonography, computed tomography, and renal isotope scanning.
- Assessment of treatment strategies including supportive care and controversial anticoagulant therapy.
Main Results:
- Ultrasonography reveals enlarged kidneys with disrupted echo patterns.
- Initial management focuses on supportive care.
- Surgical intervention is generally not indicated acutely, except in bilateral cases.
Conclusions:
- Renal venous thrombosis in neonates requires prompt diagnosis and management.
- Long-term sequelae can include impaired renal function, hypertension, and tubular defects.
- Further research into optimal anticoagulant therapy is warranted.
Abstract:
Renal venous thrombosis, a clotting process that originates in the venous radicles and progresses into the main renal vein and vena cava, predominantly affects newborn infants. It may be manifest in one or both kidneys and follow maternal diabetes, diarrhea and dehydration, congenital heart disease, acute blood loss, sepsis, asphyxia, and shock. The most common signs include gross hematuria, enlarged palpable kidneys, and thrombocytopenia. Evaluation should include ultrasonography of the kidneys (demonstrating renal enlargement with disruption of the normal echo pattern), computed tomography, and renal isotope scanning. The initial treatment is supportive. Surgical intervention is not indicated in the acute phase except in the rare instance of bilateral disease. Anticoagulant therapy is still controversial. Late sequelae include impairment of renal function, shrunken hypoplastic kidney, arterial hypertension, and tubular defects.