A Zigman1, S Yazbeck, S Emil, L Nguyen. 1. Département de Chirurgie, Hĵpital Sainte-Justine, and the Montreal Children's Hospital, Montreal, Quebec, Canada.
Abstract
PURPOSE: Renal vein thrombosis (RVT) is a rare cause for pediatric surgical consultation. The purpose of this study is to review the Montreal experience in the 1990s with RVT. METHODS: A retrospective chart review was conducted from 1990 through 1999. RESULTS: Twenty-three cases were identified by Duplex ultrasound scan. Mean length of follow-up was 42 months. Eighty-three percent (83%) of cases were diagnosed within the first month of life. In utero thrombosis was suspected in 22% and was associated with caval thrombosis and factor V Leiden. Known risk factors were present in 87%. The "diagnostic triad" of flank mass, gross hematuria, and thrombocytopenia was present in only 13% at the time of diagnosis. Long-term renal function impairment was detected in 100% of those who did not receive heparin, and in 33% of those who did receive heparin. No patient required dialysis. One patient required nephrectomy for recurrent pyelonephritis. CONCLUSIONS: RVT occurs more commonly than anticipated. Because the "classic" triad of signs usually is absent at presentation, the presence of either a flank mass, hematuria, or thrombocytopenia in a patient with risk factors should prompt investigation for RVT. Factor V Leiden is a risk factor for in utero RVT. Anticoagulation improves renal outcome. Patients with RVT require long-term follow-up.
PURPOSE:Renal vein thrombosis (RVT) is a rare cause for pediatric surgical consultation. The purpose of this study is to review the Montreal experience in the 1990s with RVT. METHODS: A retrospective chart review was conducted from 1990 through 1999. RESULTS: Twenty-three cases were identified by Duplex ultrasound scan. Mean length of follow-up was 42 months. Eighty-three percent (83%) of cases were diagnosed within the first month of life. In utero thrombosis was suspected in 22% and was associated with caval thrombosis and factor V Leiden. Known risk factors were present in 87%. The "diagnostic triad" of flank mass, gross hematuria, and thrombocytopenia was present in only 13% at the time of diagnosis. Long-term renal function impairment was detected in 100% of those who did not receive heparin, and in 33% of those who did receive heparin. No patient required dialysis. One patient required nephrectomy for recurrent pyelonephritis. CONCLUSIONS: RVT occurs more commonly than anticipated. Because the "classic" triad of signs usually is absent at presentation, the presence of either a flank mass, hematuria, or thrombocytopenia in a patient with risk factors should prompt investigation for RVT. Factor V Leiden is a risk factor for in utero RVT. Anticoagulation improves renal outcome. Patients with RVT require long-term follow-up.
Authors: Paul Monagle; Anthony K C Chan; Neil A Goldenberg; Rebecca N Ichord; Janna M Journeycake; Ulrike Nowak-Göttl; Sara K Vesely Journal: Chest Date: 2012-02 Impact factor: 9.410
Authors: P J D Winyard; T Bharucha; R De Bruyn; M J Dillon; W van't Hoff; R S Trompeter; R Liesner; A Wade; L Rees Journal: Arch Dis Child Fetal Neonatal Ed Date: 2006-02-07 Impact factor: 5.747