Abstract: TH-PO0639
A Case of Seemingly Idiopathic Renal Vein Thrombosis
Session Information
- Genetic Diseases of the Kidneys: Complex Kidney Traits
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Genetic Diseases of the Kidneys
- 1202 Genetic Diseases of the Kidneys: Complex Kidney Traits
Authors
- Cancarevic, Ivan, Mass General Brigham Inc, Boston, Massachusetts, United States
- Gelfand, Samantha L., Mass General Brigham Inc, Boston, Massachusetts, United States
Introduction
Renal vein thrombosis (RVT) most commonly occurs in individuals with nephrotic syndrome, although it can also be seen in patients suffering from malignancy, infection, or extrinsic compression of the renal vein. Spontaneous cases are extremely rare, and it is reasonable to look for a precipitating factor. RVT generally only causes acute kidney injury (AKI) only when it is bilateral or in the presence of a solitary kidney.
Case Description
We present a case of a 34-year-old woman with minimal medical history other than varicose veins since her teenage years treated by sclerotherapy who presented to the hospital with subacute flank and lower abdominal pain for about a month. About a year prior, she had an episode of gross hematuria for which she did not seek medical attention. Imaging revealed left renal vein thrombosis as well as significant collateralization and azygous vein distension. Her renal function was normal. ANCA and PLA-2R were negative and complement levels were normal. C-reactive peptide was elevated. There were no other associated symptoms. She underwent an extensive hypercoagulability workup that came back negative. She was discharged on apixaban and referred to vascular medicine and nephrology as an outpatient. Eventually, a magnetic resonance angiogram was ordered to look for possible malignancy or other vascular abnormalities. It showed a congenitally interrupted inferior vena cava between the hepatic and renal veins with extensive collaterals, which likely impaired flow leading to stasis and thrombus formation. The congenitally absent IVC is also likely the cause of her varicose veins at a young age.
Discussion
This case provides interesting insight into what may be an overlooked cause of RVT. Physiologically, congenital venous malformations can cause elevated pressure in renal veins or venous stasis, predisposing to clotting. Considering how rare spontaneous renal vein thrombosis is, it is very plausible that some of those cases may have been caused by a congenital venous anomaly like the one above. We believe that it is reasonable to do magnetic resonance vascular imaging on patients diagnosed with RVT where no other precipitating factor has been discovered.