Late-onset renal vein thrombosis: A case report and review of the literature

Abstract

INTRODUCTIONRenal vein thrombosis, a rare complication of renal transplantation, often causes graft loss. Diagnosis includes ultrasound with Doppler, and it is often treated with anticoagulation or mechanical thrombectomy. Success is improved with early diagnosis and institution of treatment.PRESENTATION OF CASEWe report here the case of a 29 year-old female with sudden development of very late-onset renal vein thrombosis after simultaneous kidney pancreas transplant. This resolved initially with thrombectomy, stenting and anticoagulation, but thrombosis recurred, necessitating operative intervention. Intraoperatively the renal vein was discovered to be compressed by a large ovarian cyst.DISCUSSIONCompression of the renal vein by a lymphocele or hematoma is a known cause of thrombosis, but this is the first documented case of compression and thrombosis due to an ovarian cyst.CONCLUSIONEarly detection and treatment of renal vein thrombosis is paramount to restoring renal allograft function. Any woman of childbearing age may have thrombosis due to compression by an ovarian cyst, and screening for this possibility may improve long-term graft function in this population.

Strangulation of intraperitoneal kidney transplant by fallopian tube

“…Both the fallopian tubes and ovaries are considered part of the uterine adnexa and lie within the contents of the iliac fossa [ 5 ]. Previously, we documented a case of an ovarian cyst compressing the renal vein of a grafted kidney in a young woman, ultimately causing renal vein thrombosis [ 2 ], and others documented intestinal obstruction caused by the fallopian tube [ 5 , 6 ]. Such rare but recurrent complications shed light on surgical approaches and female-specific considerations that need to be made intraoperatively.…”

“…Unfortunately, urinary tract infections (UTIs) are among the most common bacterial infections occurring in transplant recipients [ 1 ]. We have previously reported the first case of a 29-year-old female with sudden development of late-onset renal vein thrombosis due to compression by an ovarian cyst [ 2 ]. Here, we present a 35-year-old female who underwent SPK transplantation complicated by strangulation of the renal vein and artery of the transplanted kidney by the fallopian tube.…”

Compliance Issues in Managing 21 Hydroxylase Deficiency and their Short/Long-Term Consequences

“…It is conceivable his PEs were due to compression of his blood vessels by his large left presumed myelolipoma which would increase the risk of thrombus formation. While this has not been reported as a complication of myelolipomas, it has been seen in patients due to ovarian cysts as well as adrenocortical carcinomas [ 5 ] . CAH due to 21OH deficiency itself is associated with an increased frequency of venothromboembolic events, although previous studies on the topic have suggested it may be a consequence of iatrogenic hypercortisolism from excess glucocorticoid replacement (which was not the case with this patient) [ 6 ] .…”

Transplant renal vein thrombosis in a recipient with aberrant venous anatomy

“…Increasing sensitivity of diagnostic imaging and interventional procedures have contributed to the success of graft salvage through interventional and medical, as opposed to surgical, means [4,10]. Catheter-directed infusion of thrombolytic agents such as TPA, streptokinase, and urokinase in patients with renal transplantation with stable grafts and no other contraindications to systemic thrombolytics [11,12] can be graftsaving. After thrombolysis, ongoing anticoagulation, usually with Heparin, is indicated, with the duration of anticoagulation dependent on identification of reversible or irreversible risk factors [11].…”