Register for email alerts and news feeds:
This journal | BMJ Group
rss
Published Online First: 7 February 2006. doi:10.1136/adc.2005.083717
Archives of Disease in Childhood - Fetal and Neonatal Edition 2006;91:F273-F278
Copyright © 2006 BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health.

ORIGINAL ARTICLE

Perinatal renal venous thrombosis: presenting renal length predicts outcome

P J D Winyard1,2, T Bharucha1, R De Bruyn3, M J Dillon1,2, W van’t Hoff1,2, R S Trompeter1,2, R Liesner4, A Wade5 and L Rees1,2

1 Renal Unit, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 1JH, UK
2 Nephro-Urology, Institute of Child Health, University College London, London WC1N 1EH, UK
3 Radiology, Great Ormond Street Hospital for Children NHS Trust
4 Haematology Department, Great Ormond Street Hospital for Children NHS Trust
5 Paediatric Epidemiology and Biostatistics Units, Institute of Child Health

Correspondence to:
Correspondence to:
Dr Winyard
Nephro-Urology Unit, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK; pwinyard{at}ich.ucl.ac.uk

Background: Renal venous thrombosis (RVT) is the most common form of venous thrombosis in neonates, causing both acute and long term kidney dysfunction. Historical predisposing factors include dehydration, maternal diabetes, and umbilical catheters, but recent reports highlight associations with prothrombotic abnormalities.

Study: Twenty three patients with neonatal RVT were analysed over 15 years. Predisposing factors, presentation, and procoagulant status were compared with renal outcome using multilevel modelling.

Results: Median presentation was on day 1: 19/23 (83%) had pre/perinatal problems, including fetal distress (14), intrauterine growth retardation (five), and pre-identified renal abnormalities (two); 8/18 (44%) had procoagulant abnormalities, particularly factor V Leiden mutations (4/18). Long term abnormalities were detected in 28/34 (82%) affected kidneys; mean glomerular filtration rate was 93.6 versus 70.2 ml/min/1.73 m2 in unilateral versus bilateral cases (difference 23.4; 95% confidence interval 6.4 to 40.4; p = 0.01). No correlation was observed between procoagulant tendencies and outcome, but presenting renal length had a significant negative correlation: mean fall in estimated single kidney glomerular filtration rate was 3 ml/min/1.73 m2 (95% confidence interval 3.7 to –2.2; p = 0.001) per 1 mm increase, and kidneys larger than 6 cm at presentation never had a normal outcome.

Conclusions: This subgroup of neonatal RVT would be better termed perinatal RVT to reflect antenatal and birth related antecedents. Prothrombotic defects should be considered in all patients with perinatal RVT. Kidney length at presentation correlated negatively with renal outcome. The latter, novel observation raises the question of whether larger organs should be treated more aggressively in future.

Abbreviations: CKD, chronic kidney disease; GFR, glomerular filtration rate; MTHFR, methylenetetrahydrofolate reductase; RVT, renal venous thrombosis

Keywords: antenatal; perinatal; prognosis; prothrombotic; renal venous thrombosis


Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?

This article has been cited by other articles:

  • Young, G., Albisetti, M., Bonduel, M., Brandao, L., Chan, A., Friedrichs, F., Goldenberg, N. A., Grabowski, E., Heller, C., Journeycake, J., Kenet, G., Krumpel, A., Kurnik, K., Lubetsky, A., Male, C., Manco-Johnson, M., Mathew, P., Monagle, P., van Ommen, H., Simioni, P., Svirin, P., Tormene, D., Nowak-Gottl, U. (2008). Impact of Inherited Thrombophilia on Venous Thromboembolism in Children: A Systematic Review and Meta-Analysis of Observational Studies. Circulation 118: 1373-1382 [Abstract] [Full Text]  
  • Wang, K Y, Tsai, L W, Chen, C M (2008). Tissue plasminogen activator therapy for renal venous thrombosis. Arch. Dis. Child. Fetal Neonatal Ed. 93: F397-F398 [Full Text]  
  • Lau, K. K., Stoffman, J. M., Williams, S., McCusker, P., Brandao, L., Patel, S., Chan, A. K.C., for the Canadian Pediatric Thrombosis and Hemostas, (2007). Neonatal Renal Vein Thrombosis: Review of the English-Language Literature Between 1992 and 2006. Pediatrics 120: e1278-e1284 [Abstract] [Full Text]  

This Article

Services
Citing Articles
Google Scholar
PubMed
Topic Collections
Bookmark with

Register for free content

The full back archive is now available for all BMJ Journals. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006 right back to volume 1 issue 1. Register here to access the free archive of all BMJ Journals.

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.

Latest from ADC

 

ADC is co-owned by the RCPCH and is the official journal of the European Academy of Paediatrics

BMJ Careers - Latest Paediatrics and Paediatric Surgery Jobs

Paediatrics and Paediatric Surgery Jobs