Phlebography of the inferior vena cava with selective study of the renal veins was performed in 43 patients with systemic lupus erythematosus (SLE). Inferior vena cava thrombosis (IVCT) or renal vein thrombosis (RVT) was found in 3 of 11 patients (27%) with nephrotic syndrome, in 8 of 13 (61.5%) with previous thrombophlebitis, and in 3 of 4 (75%) with suggestive acute clinical picture. In contrast, none of the 20 control patients with SLE had IVCT or RVT. These results show that SLE patients with thrombophlebitis have a very high risk of developing IVCT or RVT; patients with nephrotic syndrome have a smaller risk. Neither IVCT nor RVT was found in SLE patients without antecedent thrombophlebitis or nephrotic syndrome.The first case of renal vein thrombosis (RVT) and inferior vena cava thrombosis (IVCT) in systemic lupus erythematosus (SLE) was described by Hamilton and Tumulty (1) in a patient with nephrotic syndrome. Nineteen more cases (2-15) have been reported since then, all retrospectively and in anecdotal fashion. Until the 1960s the diagnosis of RVT was established only in postmortem studies. Since the development of angioradiographic techniques, RVT has been found in 22% of patients with the nephrotic syndrome (10,16), and it is now recognized that it is a consequence, and not the cause, of this renal conditionIn deep vein thrombophlebitis of the lower extremities there is a certain incidence of IVCT, and thrombophlebitis is recognized as a manifestation of active SLE. This prospective study was begun to test the hypothesis that SLE patients with nephrotic syndrome or with thrombophlebitis of the lower extremities have a higher frequency of RVT or IVCT than those SLE patients who do not have these risk factors.(17-19).
PATIENTS AND METHODSPatients. Forty-three patients with SLE were studied prospectively. All patients fulfilled at least 7 of the American Rheumatism Association criteria for classification of SLE (201, and they were divided into 2 groups. Patients in group 1 were considered to be high-risk for RVT or IVCT, and were further divided as follows. Patients with nephrotic syndrome with proteinuria of at least 3.5 gm/liter per 24-hour collection for 6 months or more (21) were designated group la. Patients who, during the period of our observation, had 1 or more episodes of deep thrombophlebitis of the upper or lower extremities for which n o other cause could be found (22) comprised group lb. Patients with a clinical picture suggestive of RVT or IVCT (severe lumbar or flank pain with hematuria) (10) were designated group Ic. Group 2 was a control group of SLE patients, paired by sex, age, and duration of disease, but who did not have the aforementioned risk factors.Methods. All patients underwent simple phlebography of the inferior vena cava with selective study of the renal veins by the Seldinger technique. The catheter tip was positioned exactly at the site of the bifurcation of the renal
