Clinical Characteristics and Long-term Follow-up of Patients With Renal Vein Thrombosis
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.
1Division of Cardiovascular Medicine, Mayo Clinic and Foundation, Rochester, MN
2Division of Hematology, Mayo Clinic and Foundation, Rochester, MN
3Department and Clinic of Angiology, Diabetology, and Hypertension, University Medical School of Wroclaw, Wroclaw, Poland
4Division of Nephrology and Hypertension, Mayo Clinic and Foundation, Rochester, MN
5Division of Biostatistics, 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.
ABSTRACT