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Kidney Week

Abstract: SA-PO144

Catheter-Directed Thrombectomy in Acute Renal Vein Thrombosis

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Ames, Amanda Kyoko, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
  • Yan, Tyler D., The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
  • Da Roza, Gerald A., The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
  • Hirji, Zameer, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
  • Yang, Brian Pei Tao, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
Introduction

Renal vein thrombosis (RVT) is a rare condition that can lead to severe complications including acute kidney injury or renal failure. Malignancy and nephrotic syndrome are the most common etiologies accounting for up to 66% and 20% of cases, respectively. The standard treatment for RVT is anticoagulation, but in the presence of declining renal function or contraindications, catheter-directed thrombectomy (CDT) can be considered.

Case Description

A 64-year-old female with CKD stage IIIa, hypertension and nephrolithiasis presented with acute left flank pain, AKI (creatinine 1.35mg/dL) and a 7cm left renal subcapsular hematoma with large RVT. Urinalysis revealed trace blood and protein with urine ACR of 8.2mg/mmol. On day three, kidney function declined to creatinine of 2.1mg/dL. Due to the rapid decline in kidney function and renal hematoma, precluding anticoagulation, CDT was performed. The clot was successfully retrieved and renal flow was restored. The creatinine approached baseline within a few days. Interestingly, the pathology demonstrated fragments of renal cell carcinoma within the thrombus despite no clear evidence of malignancy on CT or MRI imaging.

Discussion

We present the successful use of CDT for acute RVT secondary to renal cell carcinoma for diagnostic and therapeutic purposes. CDT permits rapid re-cannulization of the renal vein and facilitates faster renal recovery. Direct access permits interventions including venoplasty or stent placement for persistent stenosis or elastic recoil. To our knowledge, there are no previously reported cases of thrombectomy for acute RVT secondary to tumor thrombus. CDT is a potentially safe and effective treatment option for acute RVT, especially in the setting of declining renal function or contraindications to anticoagulation.