Abstract: TH-PO524
Renal Vein Thromboses: A 10-Year Review of a Tertiary Pediatric Center Practice
Session Information
- Pediatric Nephrology - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1900 Pediatric Nephrology
Authors
- Patel, Ashish, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, Birmingham, United Kingdom
- Cynan, Miriam, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, Birmingham, United Kingdom
- Lalayiannis, Alexander D., Birmingham Women's and Children's NHS Foundation Trust, Birmingham, Birmingham, United Kingdom
Background
Renal vein thrombosis (RVT) is a rare diagnosis predominantly affecting neonates. Although uncommon, there is long-term risk of hypertension (HTN) and chronic kidney disease (CKD). RVT tends to be unilateral (70% of cases) but extension of thrombosis is common (52% of cases). There are many risk factors predisposing to RVT including genetic thrombophilia mutations.
Current management is based solely on expert opinion or small observational studies with no consensus. The choice and length of anticoagulation, if used, is variable and recommendations vary.
Methods
We reviewed our practice of RVT at a single tertiary pediatric nephrology center in the United Kingdom. We carried out a retrospective review of RVT cases over the past 10 years to evaluate our practice and develop local consensus on management.
Results
18 patients were screened, with 14 patients eligible for inclusion. Nearly all patients identified were neonates, diagnosed with RVT at a median age of 3 days. Our review found a higher proportion of cases having bilateral RVT (57%) compared to unilateral (43%), with associated thromboses occurring in 71% of cases.
86% of cases received anticoagulation initially with low molecular weight heparin (LMWH)/enoxaparin (50%), unfractionated heparin (42%) or alteplase (8%). Long term anticoagulation was predominantly LMWH (62.5%) with others receiving warfarin (25%) and one case receiving rivaroxaban. Duration of anticoagulation varied between 1 week to 6 months.
Most children (79%) were investigated with a thrombophilia screen, and 45% of those investigated had a gene mutation identified (2 with prothrombin mutation and 3 with factor V Leiden mutation).
Mortality was high (21%) with long term outcomes of HTN (50% of cases) and CKD (43% of cases) being common at 3 and 6 month follow up.
Conclusion
Our review, although small, highlighted the variability in RVT presentation and management. There were more cases of bilateral RVT with a high index of associated thrombus formation in our population. Most cases received anticoagulation, but we recognise the variation in practice and length of therapy. We highlight the need for thrombophilia screening as well as monitoring for long-term sequalae like HTN and CKD.
We recommend that larger international studies or an RVT registry are needed to achieve consensus on management between pediatric haematology and nephrology.