title: Renal vascular thrombosis in the newborn.
abstract: Neonatal renal vascular thrombosis is rare but has devastating sequelae. The renal vein is more commonly affected than the renal artery. Most neonates with renal vein thrombosis present with at least one of the three cardinal signs, namely, abdominal mass, macroscopic hematuria and thrombocytopenia, while unilateral renal artery thrombosis presents with transient hypertension. Contrast angiography is the gold standard for diagnosis but because of exposure to radiation and contrast agents, Doppler ultrasound scan is widely used instead. Baseline laboratory tests for platelet count, prothrombin time, activated partial thromboplastin time and fibrinogen concentration are essential before therapy is initiated. Maternal blood is tested for lupus anticoagulant and anticardiolipin antibody. Evaluation for prothrombotic disorders is warranted when thrombosis is clinically significant, recurrent or spontaneous. Management should involve a multidisciplinary team that includes neonatologists, radiologists, pediatric hematologists and nephrologists. In addition to supportive therapy, recent guidelines recommend at least prophylactic heparin therapy in the majority of cases to prevent thrombus extension. Thrombolytic therapy is reserved for bilateral thrombosis compromising kidney function. Long-term sequelae, such as kidney atrophy, systemic hypertension and chronic kidney disease, are common, and follow-up by pediatric nephrologists is recommended for monitoring of kidney function, early detection and management of hypertension and chronic kidney disease.
authors.affiliation: Shaw-NKF-NUH Children's Kidney Center, KTP-National University Children's Medical Institute, National University Health System, Singapore, Singapore.
authors.forename: Lourdes Paula R
authors.initials: LP
authors.lastname: Resontoc
authors.affiliation: Shaw-NKF-NUH Children's Kidney Center, KTP-National University Children's Medical Institute, National University Health System, Singapore, Singapore. paeyaphk@nus.edu.sg.|Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Tower Block 12 #1E, Kent Ridge Road, Singapore, 119228, Singapore. paeyaphk@nus.edu.sg.
authors.forename: Hui-Kim
authors.initials: HK
authors.lastname: Yap
mesh_terms: D000792:Angiography; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000502:physiology; D001779:Blood Coagulation Factors / Q000378:metabolism; D005865:Gestational Age; D006417:Hematuria / Q000209:etiology; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010976:Platelet Count; D017410:Practice Guidelines as Topic; D012078:Renal Artery Obstruction / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D012082:Renal Veins; D013921:Thrombocytopenia / Q000209:etiology; D013927:Thrombosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D018608:Ultrasonography, Doppler
chemical_list: D000925:Anticoagulants; D001779:Blood Coagulation Factors; D006493:Heparin
keywords: Chronic kidney disease; Neonate; Renal artery thrombosis; Renal vein thrombosis; Umbilical vessel catheterization