Wu C H, Ko S F, Lee C H, Cheng B C, Hsu K T, Chen J B, Chien Y S, Yang C C, Huang M C, Chuang F R
Department of Internal Medicine, Division of Nephrology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Clin Nephrol. 2006 Jun;65(6):433-40. doi: 10.5414/cnp65433.
Renal vein thrombosis (RV Thromb) is a serious complication ofnephrotic syndrome. Anticoagulation is usually recommended as the treatment of choice. This study reports 3 nephrotic patients diagnosed to have RVThromb combined with thromboembolic events. Low-molecular weight heparin (LMWHep) was given subcutaneously every 12 hours following the diagnosis of RVTromb, which continued at the outpatient clinic after an average of 11 in-hospital days. The patients visited the nephrology outpatient clinic every other week and underwent magnetic resonance image (MRI) studies at 6-week intervals for follow-up of patency of the involved renal vein. LMWHep was discontinued when MRI showed this patency. The average outpatient treatment period was 74 days. There was no recurrent RVThromb in the follow-up course of 6 months after discontinuation of LMWHep. Kidney function was preserved, as indicated by image studies and serial renal function tests. LMWHep produced a more predictable anti-coagulant effect, a superior bioavailability, a longer half-life and a dose-independent effect than unfractionated heparin and coumadin. These benefits made the outpatient treatment of RVThromb possible. Our report recommends outpatient treatment of RVThromb by LMWHep because it is feasible, effective and safe.
肾静脉血栓形成（RV血栓形成）是肾病综合征的一种严重并发症。通常推荐抗凝作为首选治疗方法。本研究报告了3例被诊断为RV血栓形成合并血栓栓塞事件的肾病患者。在诊断为RV血栓形成后，每12小时皮下注射低分子量肝素（LMWHep），平均住院11天后在门诊继续使用。患者每隔一周到肾病门诊就诊，并每隔6周进行一次磁共振成像（MRI）检查，以随访受累肾静脉的通畅情况。当MRI显示通畅时停用LMWHep。门诊平均治疗期为74天。停用LMWHep后的6个月随访过程中未出现复发性RV血栓形成。影像学检查和系列肾功能测试表明肾功能得以保留。与普通肝素和香豆素相比，LMWHep产生的抗凝作用更可预测，生物利用度更高，半衰期更长且作用不依赖剂量。这些优点使得RV血栓形成的门诊治疗成为可能。我们的报告推荐使用LMWHep对RV血栓形成进行门诊治疗，因为它可行、有效且安全。
