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Active malignancy in patients with renal vein thrombosis: influence upon clinical course and survival

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Abstract

Background

Renal vein thrombosis (RVT) is a rare event with myriad clinical manifestations. Published experience regarding the clinical course and management of RVT in patients beyond the neonatal period is limited to case reports and small case series.

Methods

A multicenter retrospective review of consecutive admitted patients with diagnosed RVT between January 2000 and May 2015 at three different university hospitals.

Results

Thirty-nine patients (53.8 % men and 46.2 % women) were included. Median age was 58 years. Malignancy (n = 19, 48.7 %), nephrotic syndrome (n = 8, 20.5 %) and infection (n = 5, 12.8 %), were the most common underlying conditions. Compared to non-cancer patients, patients with active cancer tended to be significantly older (mean age 63 ± 18 vs. 37 ± 22 years, P = 0.001) and presented with non-acute symptoms (P = 0.01) and unrevealing physical findings (P = 0.02). Thrombosis extension beyond the renal vein occurred in 69.2 % of cases and was more common in cancer patients (P = 0.001). Anticoagulation therapy was administered in 71.8 % of patients leading to resolution of thrombus in most cases (30/32 patients, 94 %) during follow-up evaluation. There were six recurrent thrombotic events during a mean follow-up of 35 ± 43 months. Nine patients (28 %) died during follow-up, all of them with malignancy.

Conclusion

Active cancer is the most common cause of RVT and should be excluded when RVT is diagnosed. Clinical course of RVT in cancer patients is more indolent and diagnosis requires high index of suspicion. Survival rates are governed by the presence of malignancy.

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Authors and Affiliations

  1. Department of Hematology, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel

    Amihai Rottenstreich, David Varon & Yosef Kalish

  2. Hematology Department, Sourasky Medical Center, Tel Aviv, Israel

    Merav Barzilai & David Varon

  3. Hematology Department, Sha’are Zedek Medical Center, Jerusalem, Israel

    Nael Da’as

  4. Braun School of Public Health and Community Medicine, Faculty of Medicine of the Hebrew University and Hadassah, Jerusalem, Israel

    Geffen Kleinstern

Authors
  1. Amihai Rottenstreich
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  2. Merav Barzilai
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  3. Nael Da’as
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  4. Geffen Kleinstern
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  5. David Varon
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  6. Yosef Kalish
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Correspondence to Yosef Kalish.

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The authors declare that they have no conflict of interest.

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Rottenstreich, A., Barzilai, M., Da’as, N. et al. Active malignancy in patients with renal vein thrombosis: influence upon clinical course and survival. Clin Exp Nephrol 21, 49–54 (2017). https://doi.org/10.1007/s10157-016-1245-0

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  • DOI: https://doi.org/10.1007/s10157-016-1245-0

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