title: Successful treatment of acute inferior vena cava and unilateral renal vein thrombosis by local infusion of recombinant tissue plasminogen activator.
abstract: Renal vein thrombosis can occur as a complication of nephrotic syndrome. We present the case of a young man with nephrotic syndrome caused by minimal change disease who developed acute inferior vena cava and left renal vein thrombosis. He was treated initially with intravenous heparin. Because of the persistence of severe left flank pain and gross hematuria, local infusion of recombinant tissue plasminogen activator was tried, with resolution of thrombi and subsidence of symptoms. Functional preservation of the involved kidney is good, as indicated by Tc-99m DMSA scan (involved kidney, 47.4%; uninvolved kidney, 52.6%). Anticoagulation is usually recommended as the treatment of choice in renal vein thrombosis. We believe that in cases with critical presentations, such as bilateral involvement, extension into inferior vena cava, acute renal failure, pulmonary embolism or severe flank pain, thrombolytic therapy should be considered as a second-line treatment if good response is not obtained with heparin.
authors.affiliation: Department of Internal Medicine, Chang Gung Memorial Hospital at Kaohsiung, Hsien, Taiwan. lamkk@ksts.seed.net.tw
authors.forename: K K
authors.initials: KK
authors.lastname: Lam
authors.forename: C C
authors.initials: CC
authors.lastname: Lui
mesh_terms: D000208:Acute Disease; D000328:Adult; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D008297:Male; D009402:Nephrosis, Lipoid / Q000150:complications; D009404:Nephrotic Syndrome / Q000150:complications; D011859:Radiography; D011994:Recombinant Proteins / Q000008:administration & dosage; D012082:Renal Veins / Q000000981:diagnostic imaging; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014463:Ultrasonography; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging; D020246:Venous Thrombosis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D006493:Heparin; D010959:Tissue Plasminogen Activator