Abstract: FR-PO013

Acute Spontaneous Bilateral Renal Vein Thrombosis in a Healthy Young Woman

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Zaw, Yuzana K, Mayo Clinic, Chandler, Arizona, United States
  • Keddis, Mira T., Mayo Clinic, Chandler, Arizona, United States
Background

Introduction:
Acute spontaneous bilateral renal vein thrombosis in native kidneys is extremely rare. We report the first case of acute spontaneous bilateral renal vein thrombosis in a healthy young woman.

Methods

Case Description:
A 26 year old Caucasian female non-smoker presented to Mayo Clinic with a chief complaint of 24hr history of acute left flank pain. She has asthma,dyslipidemia and polycystic ovarian syndrome for which she was on oral contraceptives, Azurette for 9 years and then switched to Ashlyna 4 months ago. She experienced dyspnea two weeks before which was initially attributed to her underlying asthma.
CT scan of abdomen and pelvis showed acute bilateral renal vein thrombosis with extension of thrombus to involve a long segment of IVC with associated segmental ischemia to lower pole of right kidney. CT chest showed bilateral acute pulmonary emboli. She had transient microscopic hematuria, low grade proteinuria (2grams) and acute kidney injury with serum creatinine of 1.3 mg/dL from baseline 1 mg/dL.
She was initiated on intravenous Heparin drip and transitioned to Apixaban therapy. Hypercoagulable workup was negative. She had Minera intrauterine contraceptive device placed during admission and she was advised not to use estrogen containing contraception or supplements in the future due to her history of massive thrombosis while taking oral contraceptives.

Conclusion

Discussion:
We report the first case of spontaneous bilateral renal vein thrombosis (RVT) and acute bilateral pulmonary emboli in an otherwise healthy young woman with long term contraceptive use. This case illustrates the importance of high clinical suspicion for RVT in the differential diagnosis of acute flank pain particularly, in patients with oral contraceptive use. Early recognition and prompt treatment is the corner stone of management.