A neonate may develop thrombosis of a renal vein if certain risk factors are present. A clinical suspicion can be verified by appropriate diagnostic testing.
Risk factors for renal vein thrombosis in a neonate:
(1) polycythemia
(2) dehydration
(3) maternal gestational diabetes (associated with polycythemia and respiratory distress)
(4) asphyxia
(5) sepsis
(6) hypercoagulable state (protein C deficiency, antithrombin III deficiency, congenital)
Clinical findings seen in renal vein thrombosis:
(1) solid flank mass (in both flanks if bilateral)
(2) hematuria
(3) hypertension
(4) thrombocytopenia
(5) possibly oliguria
The presence of clinical findings in a newborn infant with one or more risk factors should prompt ultrasonography or other diagnostic study.
If an underlying cause is not identified, then the infant should be evaluated for a hypercoagulable state. Since blood samples from a neonate may be difficult to collect the parents can be evaluated if a hereditary defect (Factor V Leiden, Prothrombin G20210A) is suspected.
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