Non Catether Induced Renal and Inferior Vena Cava Trombosis in a Neonate: A Case Report

Abstract

BACKGROUND:Neonatal renal vein thrombosis is the most common vascular condition in the newborn kidney, which could lead to serious complication in infants.CASE REPORT:We report a case of the unilateral renal vein and inferior vena cava thrombosis, presented with gross hematuria and thrombocytopenia in a neonate. The neonate was a macrosomic male born to a mother with hyperglycemia in pregnancy. The baby was born with perinatal asphyxia and early neonatal infection and massive hematuria. Clinical and laboratory examination showed enlarged kidney having corticomedullary differentiation diminished and azotemia. Diagnosis of renal vein thrombosis was suspected by renal ultrasound and confirmed by magnetic urography. Prothrombotic risk factors were evaluated. The child is being managed conservatively. Measures aimed at the prevention of end-stage renal disease because of its poor outcome were highlighted. Despite anticoagulant therapy, the right kidney developed areas of scarring and then atrophy.CONCLUSION:In this work, we present a patient with multiple entities in the aetiology of non-catheter induced renal and vena cava thrombosis in a neonate. Clinicians should suspect renal vein thrombosis in neonates when presented with early postnatal gross hematuria, palpable abdominal mass and thrombopenia.

Inferior vena cava syndrome in neonates: An evidence‐based systematic review of the literature

“…Four hundred seventy‐two articles were identified and 33 were included; 28 case reports, 3 case series, and 2 retrospective cohort studies (Supporting Information Table S1), with a combined total of 34 patients from case reports/case series and 27 from cohort studies (Figure ). Selected articles included all patients with radiological evidence of IVCS ( n = 61; 57 of which were clinically symptomatic).…”

“…In one case, antithrombin deficiency (activity 37%) was identified as a co‐predisposing factor for thrombosis, together with the methylene tetrahydrofolate reductase (MTHFR) gene . Abnormalities in the MTHFR gene have been correlated with caval thrombosis in neonates, and gene polymorphism was identified as a single prothrombotic risk factor in four cases . Of note, the MTHFR mutation is no longer identified as a sole risk factor for venous thrombosis, unless the patient has a decreased homocysteine level.…”

“…Most systemic infections cause hemostatic instability through tissue factor‐mediated thrombin generation, downregulation of physiological anticoagulant mechanisms, and inhibition of fibrinolysis . In three cases— Escherichia coli and Acinetobacter baumannii bacteremia , persistent candidiasis, and early‐onset neonatal infection—sepsis was proposed as the cause of IVC thrombosis . Sepsis and prolonged CVC duration with concurrent IVC thrombosis is well documented …”

“…Heterozygosity and homozygosity for factor V Leiden mutation (FV:Q506) is associated with a 5‐ to 10‐fold and 50‐ to 100‐fold increased risk of thrombosis, respectively . In four cases, MTHFR gene polymorphism was identified as a single prothrombotic risk factor . The authors used the term “mutation” to describe the genetic aberration, which we discourage.…”

“…Table summarizes treatment modalities for neonatal IVCS and the duration and presence of complications where pertinent. Thrombus resolution was achieved in five of six patients treated with LMWH, and in three patients, clinical improvement occurred with heparin and antithrombin . Among four patients treated with heparin and tPA, the average time to IVC repermeabilization was 5.3 days.…”