Acute pyelonephritis with renal vein and inferior vena cava thrombosis in a case of hyperhomocysteinemia

Abstract

Acute pyelonephritis is not considered a common cause of renal vein (RVT) and inferior vena caval thrombosis (IVCT). Apart from malignancy, RVT is not an uncommon condition amongst patients with nephrotic syndrome, most commonly seen in patients with membranous glomerulonephritis. However, RVT occurring in association to acute pyelonephritis is rare. Clinically, it is difficult to distinguish between acute pyelonephritis and RVT because both present with fever, flank pain, and hematuria. We report a case of acute pyelonephritis with RVT and IVCT with underlying hyperhomocysteinemia. The patient was treated with systemic anticoagulation, antibiotics, and B complex therapy. At 3 months follow-up, there was complete resolution of thrombus but the left kidney was nonfunctioning.

Acute pyelonephritis with renal vein and inferior vena cava thrombosis and pulmonary emboli in poorly controlled type 2 diabetes and HHS

“…Extension of thrombosis into the inferior vena cava and pulmonary emboli have both been reported previously as complications of renal vein thrombosis . Management is by anticoagulation alongside treatment of the underlying cause.…”

“…Renal vein thrombosis as a complication of acute pyelonephritis is rare and poorly recognised . The literature is confined to a few case reports . Acute pyelonephritis and sepsis can cause a hypercoaguable state which may predispose to thrombosis of the renal vein .…”

Renal vein thrombosis complicating severe acute pyelonephritis with renal abscesses and associated bacteraemia caused by extended-spectrum beta-lactamase producing Escherichia coli

“…Renal vein thrombosis occurs mainly due to systemic hypercoagulable states, the most common being nephrotic syndrome with urinary losses of anticoagulant proteins [4]. Other prothrombotic aetiologies of renal vein thrombosis include hyperhomocysteinemia, antiphospholipid syndrome, paroxysmal nocturnal hemoglobinuria, renal cell carcinoma or other active malignancy, renal transplantation, trauma, postpartum, oral contraceptive use and sepsis syndrome [5][6][7][8][9][10]. Only seven previous cases of RVT complicating acute pyelonephritis or renal and perirenal abscesses have been described [1].…”

Acute Pyelonephritis: The Clot Unfolds, Evidence than Supports Complex Nature of the Renal Vein Thrombosis; Therapeutical Implications

“…The recent case published on Renal Vein Thrombosis (RVT) due to acute pyelonephritis (APN) is an important contribution to the clinical management of thrombophilia [1][2][3]. Considering that acute pyelonephritis is not contemplated as a common cause of renal RVT and inferior vena cava thrombosis (IVCT), but not an uncommon condition amongst patients with nephrotic syndrome (NS) and commonly seen in patients with membranous glomerulonephritis [4], requires that physicians take into consideration genetic causes and other risk factors that leads to thrombophilia. Previously, the association of RVT with acute pyelonephritis was reported in probands with sepsis plus trombotic risk factor as can be seen in hyperhomocysteinemia or diabetes mellitus [4][5][6][7].…”

“…Considering that acute pyelonephritis is not contemplated as a common cause of renal RVT and inferior vena cava thrombosis (IVCT), but not an uncommon condition amongst patients with nephrotic syndrome (NS) and commonly seen in patients with membranous glomerulonephritis [4], requires that physicians take into consideration genetic causes and other risk factors that leads to thrombophilia. Previously, the association of RVT with acute pyelonephritis was reported in probands with sepsis plus trombotic risk factor as can be seen in hyperhomocysteinemia or diabetes mellitus [4][5][6][7]. In order to explain the physiopathology of RVT seen ocassionaly in patients with pyelonephritis it is important to explore the possibility of hyperhomocysteinemia in the case described by Talwar et al, who had diabetes but without sepsis.…”