Asymptomatic renal-vein thrombosis in adult nephrotic syndrome ultrasonography and urinary fibrin-fibrinogen products: a prospective study.
OBJECTIVE
The diagnosis of renal vein thrombosis (RVT), a frequent complication of adult nephrotic syndrome (NS), is generally made by means of invasive methods, i.e. renal venography, venous time of renal arteriography and, more recently, computed tomography (CT). We undertook a prospective study to evaluate the use of Doppler ultrasonography (DUS) and urinary fibrin-fibrinogen degradation products (FDPU) for the diagnosis of asymptomatic RVT.


METHODS
Thirty-one adult NS with non proliferative glomerulonephritis were studied. Reference procedures [(selective renal arteriography (n = 18) and renal vein CT (n = 13)] were performed blindly within a few days (48 hours in 17 patients) of renal vein DUS (search for a lack of venous flow) and measurement of FDPU (5 micrograms/min) (in 24 patients).


RESULTS
DUS was not interpretable in one patient and positive in nine. Of these 9 patients, RVT was detected by reference methods in only two (sensitivity: 1, specificity: 0.75; positive predictive value: 0.22; negative predictive value: 1). Increased FDPU was observed in 4 patients, 2 of whom had an RVT (sensitivity: 1, specificity: 0.9; positive predictive value: 0.5; negative predictive value: 1).


CONCLUSIONS
We conclude that DUS and FDPU are helpful for screening of RVT in asymptomatic NS patients; their negativity allow further radiological investigations to be avoided while positive results must be confirmed by reference methods.
Rostoker
G
G
Department of Nephrology, Hôpital Henri Mondor, Créteil, France.
Texier
J P
JP
Jeandel
B
B
Rahmouni
A
A
Mathieu
D
D
Gouault-Heilmann
M
M
Vasile
N
N
Lagrue
G
G
Weil
B
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D005188:False Negative Reactions; D005189:False Positive Reactions; D005338:Fibrin Fibrinogen Degradation Products / Q000652:urine*; D006801:Humans; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000150:complications*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012082:Renal Veins; D012680:Sensitivity and Specificity; D013927:Thrombosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000652:urine*; D014463:Ultrasonography
D005338:Fibrin Fibrinogen Degradation Products