Successful treatment of acute inferior vena cava and unilateral renal veinthrombosis by local infusion of recombinant tissue plasminogen activator

Renal vein thrombosis can occur as a complication of nephrotic syndrome. We present the case of a young man with nephrotic syndrome caused by minimal change disease who developed acute inferior vena cava and left renal vein t hrombosis. He was treated initially with intravenous heparin. Because of th e persistence of severe left flank pain and gross hematuria, local infusion of recombinant tissue plasminogen activator was tried, with resolution of thrombi and subsidence of symptoms. Functional preservation of the involved kidney is good, as indicated by Tc-99m DMSA scan (involved kidney, 47.4%; uninvolved kidney, 52.6%). Anticoagulation is usually recommended as the tr eatment of choice in renal Vein thrombosis. We believe that in cases with c ritical presentations, such as bilateral involvement, extension into inferi or vena cava, acute renal failure, pulmonary embolism or severe flank pain, thrombolytic therapy should be considered as a second-line treatment if go od response is not obtained with heparin. (C) 1998 by the National Kidney F oundation, Inc.