Clinical Characteristics and Long-term Follow-up of Patients With Renal Vein Thrombosis

Wysokinski, Waldemar E.; Gosk-Bierska, Izabela; Greene, Eddie L.; Grill, Diane; Wiste, Heather; McBane, Robert D.

doi:10.1053/j.ajkd.2007.10.030

« Previous Next »American Journal of Kidney Diseases
Volume 51, Issue 2 , Pages 224-232, February 2008

Clinical Characteristics and Long-term Follow-up of Patients With Renal Vein Thrombosis

Waldemar E. Wysokinski, MD
- Division of Cardiovascular Medicine, Mayo Clinic and Foundation, Rochester, MN
- Division of Hematology, Mayo Clinic and Foundation, Rochester, MN
Izabela Gosk-Bierska, MD
- Department and Clinic of Angiology, Diabetology, and Hypertension, University Medical School of Wroclaw, Wroclaw, Poland
Eddie L. Greene, MD
- Division of Nephrology and Hypertension, Mayo Clinic and Foundation, Rochester, MN
Diane Grill, MS
- Division of Biostatistics, Mayo Clinic and Foundation, Rochester, MN
Heather Wiste, MS
- Division of Biostatistics, Mayo Clinic and Foundation, Rochester, MN
Robert D. McBane II, MD
- Division of Cardiovascular Medicine, Mayo Clinic and Foundation, Rochester, MN
- Division of Hematology, Mayo Clinic and Foundation, Rochester, MN
- Address correspondence to Robert D. McBane II, MD, Division of Cardiovascular Medicine, Mayo Clinic and Foundation for Education and Research, 200 SW First St, Rochester, MN 55905.

Received 19 April 2007; accepted 5 October 2007. published online 21 December 2007.

Background

To determine whether treatment guidelines for patients with lower-extremity venous thrombosis (DVT) could be applied to patients with renal vein thrombosis (RVT). The rates of recurrent venous thrombosis and survival for patients with these 2 diseases were compared.

Study Design

Inception cohort of individuals was identified with their first lifetime incident of RVT. Recurrent thrombosis and survival were compared with those for patients with DVT in a case-control fashion.

Setting & Participants

All patients with a diagnosis of RVT at Mayo Clinic from 1980 to 2000.

Outcomes & Measures

Survival and recurrent venous thrombosis rates were compared with those for patients with DVT. Survival rates were also compared with those for US white residents.

Results

218 patients (mean age, 55 ± 19 years) were included (35% women). Malignancy (66%) and nephrotic syndrome (20%) were the most common underlying causes. Warfarin was prescribed for 74 patients (46% with lifelong therapy). During a mean follow-up of 42 ± 57 months (768 patient-years), there were 8 recurrent venous thrombotic events (1.0/100 patient-years). This recurrence rate was less than that for patients with DVT (P < 0.001). Survival was lower compared with patients with DVT or age- and sex-matched US white residents (P < 0.001). Active malignancy (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.2 to 4.7) and infection (HR, 2.4; 95% CI, 1.4 to 4.0) were associated with poor survival. Survival was influenced positively by warfarin therapy (HR, 0.53; 95% CI, 0.31 to 0.90).

Limitations

Retrospective nonrandomized study.

Conclusions

RVT represents a distinct clinical entity with unique recurrence and survival rates. The finding of RVT should prompt a thorough evaluation for an underlying renal malignancy. Oral anticoagulation therapy may be associated with a survival advantage.

Index Words: Renal vein thrombosis, nephrotic syndrome, renal cell cancer