Renal Vein Thrombosis in the Neonate



Renal vein thrombosis (RVT) is a multifactorial disease that predominantly affects newborn infants. It may follow maternal diabetes, asphyxia, hypertonic dehydration, congenital heart disease, acute blood loss, shock, presence of an indwelling umbilical venous catheter and sepsis. A review of the literature showed that RVT of the newborn might be of unknown etiology and probably occurs before birth. Genetic mutations, such as factor V Leiden, is a risk factor especially for in utero RVT. Other risk factors include prolonged central venous cannulation, hereditary thrombophilia, trauma, burns, and Wilms tumor. In the adult and children it is often a silent complication of the nephrotic syndrome, the hypercoagulability of which may be an important factor in the pathogenesis of the thrombosis.

The disease may manifest in one or both kidneys with a male preponderance at the ratio of 2:1.

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 diagnostic approach is with ultrasound studies and computed tomography; definitive diagnosis is established by renal venography or by selective renal arteriography In general, a conservative approach, including the use of anticoagulant treatment, is preferred to surgical intervention. Surgical intervention is not indicated in the acute phase except in the rare instance of bilateral disease or to control arterial hypertension. Late sequelae include impairment of renal function, shrunken hypoplastic kidney, arterial hypertension and tubular defects.
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We therefore report a recent case of bilateral RVT in a macrosomic male infant seen in our hospital with review of available literature.

Category: Main

Tags: breastfeeding, Nigerian neonate, renal vein thrombosis

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