-
BMC Nephrology Sep 2022Performing percutaneous renal biopsy procedures in lupus nephritis (LN) and nephrotic syndrome presents a unique challenge to the nephrologist because of the risk of...
BACKGROUND
Performing percutaneous renal biopsy procedures in lupus nephritis (LN) and nephrotic syndrome presents a unique challenge to the nephrologist because of the risk of bleeding from the procedure and the hypercoagulable state in hypoalbuminemia. The management of a patient with venous thrombosis with perinephric hematoma post renal biopsy can be difficult if occurred.
CASE PRESENTATION
We are presenting a case of perinephric hematoma following percutaneous renal biopsy in a 23-year-old man with lupus nephritis, nephrotic syndrome, and lower limbs deep vein thrombosis (DVT). The patient developed persistent frank haematuria, flank pain and acute urinary retention post-procedure. We have withheld his oral warfarin three days before the procedure, and no anticoagulation was given subsequently. Initial CT Angiography (CTA) renal showing stable hematoma and no visible evidence of vascular injury. Three weeks later, the patient still has persistent frank haematuria and a repeated CTA renal revealed new bilateral renal vein thrombosis. Considering the high risk of worsening symptomatic venous thrombosis, we gave subcutaneous enoxaparin sodium and restart oral warfarin despite ongoing haematuria. The frank haematuria resolved within two days of anticoagulation with no radiological evidence of worsening of the perinephric hematoma. The follow-up ultrasonography a month later showed resolution of the hematoma and renal vein thrombosis with no adverse effect.
CONCLUSION
Our experience, in this case, highlighted the importance of case selection for percutaneous renal biopsy among high-risk patients. Additionally, a prolonged frank haematuria in post-renal biopsy with nephrotic syndrome warranted a reassessment, as a clinical presentation of post-procedure perinephric hematoma and renal vein thrombosis can overlap. We also demonstrated that restarting anticoagulation earlier than four weeks in a patient with renal vein thrombosis and post-renal biopsy perinephric hematoma can be safe in the selective case.
Topics: Adult; Biopsy; Enoxaparin; Gastrointestinal Hemorrhage; Hematoma; Hematuria; Humans; Kidney Diseases; Lupus Nephritis; Male; Nephrotic Syndrome; Renal Veins; Ureteral Diseases; Venous Thrombosis; Warfarin; Young Adult
PubMed: 36085017
DOI: 10.1186/s12882-022-02935-z -
Journal of Vascular Surgery. Venous and... Jan 2015Chronic pelvic pain accounts for up to 30% of outpatient gynecologic visits in the United States, potentially affecting up to 40% of the female population during their... (Review)
Review
BACKGROUND
Chronic pelvic pain accounts for up to 30% of outpatient gynecologic visits in the United States, potentially affecting up to 40% of the female population during their lifetime. Pelvic congestion syndrome (PCS) is defined as chronic pelvic pain resulting from reflux or obstruction of the gonadal, gluteal, or periuterine veins, sometimes associated with perineal or vulvar varices. It can also be caused by compression of the left renal vein (LRV) between the superior mesenteric artery and the aorta, also known as the nutcracker syndrome. Whereas PCS accounts for up to 30% of patients presenting with chronic pelvic pain, it is frequently underdiagnosed. We reviewed the literature to investigate the current state of the diagnosis and treatment of this disorder.
METHODS
An online database search was performed with MEDLINE. MeSH headings included PCS, chronic pelvic pain, ovarian vein reflux, nutcracker syndrome, renal vein obstruction, pelvic varicosities, labial varicosities, embolization, treatment, and therapies.
RESULTS
Our MEDLINE search revealed more than 3756 references to chronic pelvic pain. Specific references to PCS, pelvic chronic pain, ovarian vein reflux, nutcracker syndrome, renal vein obstruction, pelvic varicosities, labial varicosities, embolization, treatment, and therapies, however, included only 260 references. Thirty-seven references were small series including fewer than 50 patients or individual case reports documenting medical, surgical, or endovascular treatment of PCS. The majority of these papers demonstrated successful treatment of symptoms from PCS with embolization of one or both ovarian veins in addition to treatment of refluxing internal iliac vein branches. In addition, open surgery and, more recently, endovascular stenting of LRV obstruction have shown some promise in alleviating symptoms attributed to nutcracker syndrome.
CONCLUSIONS
Diagnosis of PCS requires a careful history, physical examination, and noninvasive imaging. Several large case series have demonstrated the efficacy of embolotherapy in the reduction of pelvic pain; thus, it is the most favored treatment option for patients with PCS. For patients with outflow obstruction due to nutcracker syndrome, a limited number of studies have demonstrated remission of symptoms with stenting of the LRV as an alternative to open surgery.
Topics: Chronic Pain; Embolization, Therapeutic; Female; Humans; Ovary; Pelvic Pain; Renal Veins; Syndrome; Varicose Veins
PubMed: 26993690
DOI: 10.1016/j.jvsv.2014.05.007 -
Korean Journal of Radiology 2008To evaluate the dynamic changes of the power Doppler (PD) in acute renal vein occlusion and recanalization in a canine model.
OBJECTIVE
To evaluate the dynamic changes of the power Doppler (PD) in acute renal vein occlusion and recanalization in a canine model.
MATERIALS AND METHODS
We performed a PD of the kidney during graded renal vein occlusion and recanalization induced by balloon inflation and deflation in nine dogs. The PD images were transferred to a personal computer, and the PD signals were quantified.
RESULTS
We observed the temporal change of the PD signal during renal vein occlusion and recanalization, with a decrease in the PD signal during occlusion and an increase during recanalization. The mean PD signal decreased gradually as the renal vein was occluded, and conversely increased gradually with sequential relief of occlusion. The sequential change of the mean value of the PD signal was statistically significant.
CONCLUSION
The PD can detect a change in renal blood flow during acute renal vein occlusion and recanalization in a canine model. The PD may be used as a helpful tool for the early detection of acute renal vein thrombosis and the monitoring of renal perfusion.
Topics: Acute Disease; Animals; Balloon Occlusion; Blood Flow Velocity; Catheterization; Disease Models, Animal; Dogs; Image Processing, Computer-Assisted; Kidney; Renal Veins; Ultrasonography, Doppler
PubMed: 18385559
DOI: 10.3348/kjr.2008.9.2.128 -
Vascular Pharmacology Jul 2018Renal sympathetic activity affects blood pressure in part by increasing renovascular resistance via release of norepinephrine (NE) from sympathetic nerves onto renal...
Renal sympathetic activity affects blood pressure in part by increasing renovascular resistance via release of norepinephrine (NE) from sympathetic nerves onto renal arteries. Here we test the idea that adipose tissue adjacent to renal blood vessels, i.e. renal perivascular adipose tissue (RPVAT), contains a pool of NE which can be released to alter renal vascular function. RPVAT was obtained from around the main renal artery/vein of the male Sprague Dawley rats. Thoracic aortic PVAT and mesenteric PVAT also were studied as brown-like and white fat comparators respectively. RPVAT was identified as a mix of white and brown adipocytes, because of expression of both brown-like (e.g. uncoupling protein 1) and white adipogenic genes. All PVATs contained NE (ng/g tissue, RPVAT:524 ± 68, TAPVAT:740 ± 16, MPVAT:96 ± 24). NE was visualized specifically in RPVAT adipocytes by immunohistochemistry. The presence of RPVAT (+RPVAT) did not alter the response of isolated renal arteries to NE compared to responses of arteries without RPVAT (-RPVAT). By contrast, the maximum contraction to the sympathomimetic tyramine was ~2× greater in the renal artery +PVAT versus -PVAT. Tyramine-induced contraction in +RPVAT renal arteries was reduced by the α-adrenoceptor antagonist prazosin and the NE transporter inhibitor nisoxetine. These results suggest that tyramine caused release of NE from RPVAT. Renal denervation significantly (>50%) reduced NE content of RPVAT but did not modify tyramine-induced contraction of +RPVAT renal arteries. Collectively, these data support the existence of a releasable pool of NE in RPVAT that is independent of renal sympathetic innervation and has the potential to change renal arterial function.
Topics: Adipose Tissue, Brown; Adipose Tissue, White; Animals; Dose-Response Relationship, Drug; Male; Norepinephrine; Paracrine Communication; Rats, Sprague-Dawley; Renal Artery; Renal Veins; Signal Transduction; Sympathectomy; Sympathetic Nervous System; Vasoconstriction; Vasoconstrictor Agents
PubMed: 29454047
DOI: 10.1016/j.vph.2018.02.004 -
The Journal of the American Osteopathic... Sep 2019
Topics: Abdominal Pain; Adolescent; Female; Humans; Renal Veins; Tomography, X-Ray Computed; Venous Thrombosis
PubMed: 31449310
DOI: 10.7556/jaoa.2019.107 -
Journal of the National Medical... Dec 2004We report a case of bilateral renal vein thrombosis in a neonate, and reviewed available literature. The neonate was a macrosomic male born to a mother with glycosuria... (Review)
Review
We report a case of bilateral renal vein thrombosis in a neonate, and reviewed available literature. The neonate was a macrosomic male born to a mother with glycosuria in pregnancy. There was delay in commencing breasttfeeding for up to 36 hours due to lack of lactation by themother. Clinical and laboratory examination showed enlarged palpable kidneys and azotemia. Diagnosis of bilateral renal vein thrombosis was confirmed by renal ultrasonography. The child is being managed conservatively. Measures aimed at prevention of the disease because of its poor outcome were highlighted.
Topics: Breast Feeding; Fetal Macrosomia; Humans; Infant, Newborn; Male; Renal Veins; Time Factors; Ultrasonography; Venous Thrombosis
PubMed: 15622696
DOI: No ID Found -
Annals of Vascular Surgery Aug 2023Nutcracker syndrome (NCS) is an uncommon syndrome that presents with signs and symptoms caused by compression of the left renal vein (LRV), whereas 'nutcracker...
BACKGROUND
Nutcracker syndrome (NCS) is an uncommon syndrome that presents with signs and symptoms caused by compression of the left renal vein (LRV), whereas 'nutcracker phenomenon' is solely used to refer to the anatomical configuration without clinical symptoms. Treatment for NCS may include nonoperative management, open surgical intervention, and in some instances endovascular stenting. We present a single-center retrospective case series of patients who presented with NCS managed with open surgical interventions.
METHODS
A single-center, retrospective review of patients managed from 2010-2021. We diagnosed NCS via a thorough clinical examination and additional cross-sectional imaging studies including magnetic resonance venography and/or computed tomography venography. For further confirmation of the diagnosis, duplex ultrasound was frequently combined with contrast venography.
RESULTS
Thirty eight patients were included in our study from 2010-2021. Twenty one (55.3%) patients presented with symptoms including flank pain, abdominal pain, hematuria, and fatigue. The remaining 17 (44.7%) patients had nutcracker phenomenon. Within the group of patients diagnosed with NCS, 11 patients underwent LRV transposition. Symptoms related to NCS improved in 10 patients. Hematuria in 1 patient did not improve.
CONCLUSIONS
Transposition of the LRV is an effective treatment for NCS. Nonoperative management is an option for those patients experiencing less severe or nonspecific clinical symptoms.
Topics: Humans; Retrospective Studies; Hematuria; Renal Nutcracker Syndrome; Treatment Outcome; Renal Veins
PubMed: 37023926
DOI: 10.1016/j.avsg.2023.03.030 -
The Journal of International Medical... Sep 2023Only a few cases of renal vein thrombosis (RVT) occurring in patients with vasculitis have been reported. RVT associated with vasculitis and hemolytic anemia has not...
Only a few cases of renal vein thrombosis (RVT) occurring in patients with vasculitis have been reported. RVT associated with vasculitis and hemolytic anemia has not been reported yet. We describe here a patient with RVT complicated by pulmonary embolism, autoimmune hemolytic anemia, and eosinophilic granulomatous polyangiitis. A 69-year-old Japanese man who had been treated with corticosteroids was referred to our department for severe proteinuria (4.32 g/gCr). Abdominal ultrasonography showed bilateral RVT, and contrast-enhanced computed tomography showed bilateral pulmonary embolism. Therefore, the patient was diagnosed with RVT complicated by pulmonary embolism. Anticoagulation therapy with heparin followed by apixaban was started. Thereafter, the D-dimer concentration decreased from 8.3 to 1.2 μg/mL, and urinary protein excretion improved to 0.62 g/gCr. Renal function was unchanged with an estimated glomerular filtration rate of 68.8 mL/minute/1.73 m. The thrombi in both renal veins and pulmonary arteries gradually regressed. Clinicians should be aware of this complication when worsening proteinuria is observed during steroid therapy in patients with autoimmune hemolytic anemia and eosinophilic granulomatous polyangiitis.
Topics: Male; Humans; Aged; Anemia, Hemolytic, Autoimmune; Renal Veins; Venous Thrombosis; Pulmonary Embolism; Vasculitis
PubMed: 37756584
DOI: 10.1177/03000605231200272 -
The Journal of International Medical... Sep 2022Percutaneous nephrostomy is a critical procedure for establishing surgical pathways from the skin to the renal collecting system. The drainage tube involved in the...
Percutaneous nephrostomy is a critical procedure for establishing surgical pathways from the skin to the renal collecting system. The drainage tube involved in the procedure rarely deviates into the renal vein. Herein, we report three cases in which the related drainage tube was mistakenly inserted into the renal vein and inferior vena cava after the renal vein was injured during percutaneous nephrostomy. In the three cases, the nephrostomy tube and double-J tube were gradually withdrawn from the renal pelvis or renal calyces under computed tomography (CT) monitoring. In case 1, the fistula tube was not completely withdrawn in time into the renal, causing multiple thromboses in the vein. The fistula was successfully withdrawn from the vena cava after the filter was placed. Finally, the stones were cleared in two cases and one case was discharged without complications after substantial renal function recovery. A safe and reliable approach is to gradually withdraw, within a short timeframe and under CT monitoring, an ectopic renal vein or inferior vena cava drainage tube into the renal pelvis. Removal of the catheter to the renal pelvis or calyces within 3 days can reduce thrombotic complications.
Topics: Drainage; Humans; Kidney Pelvis; Nephrostomy, Percutaneous; Renal Veins; Vena Cava, Inferior
PubMed: 36168704
DOI: 10.1177/03000605221126382 -
Journal of Proteomics Jan 2019Liquid biopsies, as blood and urine, could offer an invaluable, easily accessible source of biomarkers, and evidences for elucidating the pathological processes. Only...
Liquid biopsies, as blood and urine, could offer an invaluable, easily accessible source of biomarkers, and evidences for elucidating the pathological processes. Only few studies integrated the proteomes driven by more than one biofluid. Furthermore, it is not clear which biofluid better mirrors the alterations triggered by disease. Venous infiltrating RCC(Renal Cell Carcinoma) could represent an advantageous model for exploring this aspect. Herein, we investigate how blood and urine "proteomically" reflect the changes occurring during RCC infiltration into renal vein(RV) by label-free nLC-ESI-MS/MS. We found 574 and 58 differentially expressed proteins(DEPs) in response to vascular involvement. To the augment of vascular involvement, the abundance of only three proteins in urine(UROM,RALA,CNDP1) and two in plasma(APOA1,K2C1) diminished while increased for twenty-six urinary proteins. 80 proteins were found both in urine and plasma, among which twenty-eight were DEPs. A huge overlap between the two biofluids was highlighted, as expected, being urine the filtrate of blood. However, this consistency decreases when RV-occlusion occurs suggesting alternative protein releases, and a loss of kidney architecture. Moreover, several proteomic and functional signatures were biofluid-specific. In conclusion, the complementarity between the specimens allowed to achieve a deeper level of molecular complexity of the RCC venous infiltration. SIGNIFICANCE: Although plasma and urine are strongly interconnected, only few proteomic studies investigated the complementarity of these fluids as bio-sources of information. Moreover, none of them was focused to their analysis and comparison in the context of vascular infiltration of renal cancer. Herein, new insights were gained regarding the impact into urinary and plasma proteome of the changes triggered by the ccRCC invasion into vascular system and renal vein. Furthermore, the integration of the information driven by the two liquid biopsies permits to unravel biological processes otherwise lost.
Topics: Biomarkers, Tumor; Carcinoma, Renal Cell; Chromatography, Liquid; Humans; Kidney Neoplasms; Liquid Biopsy; Neoplasm Invasiveness; Plasma; Proteome; Proteomics; Renal Veins; Tandem Mass Spectrometry; Urine
PubMed: 29689304
DOI: 10.1016/j.jprot.2018.04.029