title: Active malignancy in patients with renal vein thrombosis: influence upon clinical course and survival.
abstract: BACKGROUND
  Renal vein thrombosis (RVT) is a rare event with myriad clinical manifestations. Published experience regarding the clinical course and management of RVT in patients beyond the neonatal period is limited to case reports and small case series.
  
  
  METHODS
  A multicenter retrospective review of consecutive admitted patients with diagnosed RVT between January 2000 and May 2015 at three different university hospitals.
  
  
  RESULTS
  Thirty-nine patients (53.8 % men and 46.2 % women) were included. Median age was 58 years. Malignancy (n = 19, 48.7 %), nephrotic syndrome (n = 8, 20.5 %) and infection (n = 5, 12.8 %), were the most common underlying conditions. Compared to non-cancer patients, patients with active cancer tended to be significantly older (mean age 63 ± 18 vs. 37 ± 22 years, P = 0.001) and presented with non-acute symptoms (P = 0.01) and unrevealing physical findings (P = 0.02). Thrombosis extension beyond the renal vein occurred in 69.2 % of cases and was more common in cancer patients (P = 0.001). Anticoagulation therapy was administered in 71.8 % of patients leading to resolution of thrombus in most cases (30/32 patients, 94 %) during follow-up evaluation. There were six recurrent thrombotic events during a mean follow-up of 35 ± 43 months. Nine patients (28 %) died during follow-up, all of them with malignancy.
  
  
  CONCLUSIONS
  Active cancer is the most common cause of RVT and should be excluded when RVT is diagnosed. Clinical course of RVT in cancer patients is more indolent and diagnosis requires high index of suspicion. Survival rates are governed by the presence of malignancy.
authors: Department of Hematology, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel.
authors: Amihai
authors: A
authors: Rottenstreich
authors: Hematology Department, Sourasky Medical Center, Tel Aviv, Israel.
authors: Merav
authors: M
authors: Barzilai
authors: Hematology Department, Sha'are Zedek Medical Center, Jerusalem, Israel.
authors: Nael
authors: N
authors: Da'as
authors: Braun School of Public Health and Community Medicine, Faculty of Medicine of the Hebrew University and Hadassah, Jerusalem, Israel.
authors: Geffen
authors: G
authors: Kleinstern
authors: Department of Hematology, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel.|Hematology Department, Sourasky Medical Center, Tel Aviv, Israel.
authors: David
authors: D
authors: Varon
authors: Department of Hematology, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel. ykalish@gmail.com.
authors: Yosef
authors: Y
authors: Kalish
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D002648:Child; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007557:Israel; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D012082:Renal Veins; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D055815:Young Adult
chemical_list: D000925:Anticoagulants
keywords: Cancer; Malignancy; Nephrotic syndrome; Renal vein thrombosis