TREATMENT

Patients diagnosed with either acute or chronic renal vein thrombosis require anticoagulation treatment. Unfractionated or low molecular weight heparin is appropriate for initial treatment. Although most patients have adequate antithrombin III levels for heparin treatment, the rare patient with extremely low levels may require fresh frozen plasma. Patients should undergo subsequent transition to warfarin, with a target international normalized ratio (INR) of 2.0 to 3.0, and continue on this therapy for as long as the nephrotic syndrome remains. If there are contraindications to anticoagulation, an inferior vena cava filter may be placed. In addition, in the rare case of acute RVT, percutaneous thrombectomy or thrombolysis may be considered. Open surgery should be reserved for those patients with renal failure and bilateral acute thrombosis who cannot be treated with percutaneous techniques.