Michot C, Garnier A, Neve M, Naudin J, Tsapis M, Dauger S
Service de réanimation et surveillance continue pédiatriques, pôle de pédiatrie aiguë et médecine interne, hôpital Robert-Debré, AP-HP, université Paris-Diderot, Paris-VII, 48, boulevard Sérurier, 75019 Paris, France.
Arch Pediatr. 2011 Oct;18(10):1055-61. doi: 10.1016/j.arcped.2011.07.011. Epub 2011 Sep 1.
Neonatal renal venous thrombosis (NRVT) is a rare disease, with variable consequences on kidney function. We report a retrospective study of 9 newborns with NRVT admitted to our hospital from 1996 to 2005. The median age at diagnosis was 2 days (range, 1-10 days). In 7 patients, diagnosis was suspected based on one classical clinical or biological sign and was confirmed by ultrasound. Seven newborns had at least one known obstetrical or neonatal risk factor. NRVT was unilateral in three cases, was bilateral in 6 cases, and was associated with inferior vena cava thrombosis in 5 patients, with surrenal hemorrhage in 3 patients. Three patients did not receive specific treatment. The median delay between diagnosis and specific treatment was 20 h (range, 3-36 h). Three patients were treated by fibrinolysis, including 2 with bilateral NRVT, 2 newborns received heparins, and 1 patient was treated with a vitamin K antagonist. With a median evaluation time of 5 years and 2 months for 6 patients, 5 patients recovered their kidney function completely and the 6th child has moderate renal failure. It seems illusory to wait for randomized control studies to appreciate the potential long-term benefit of treatments on kidney function after a NRVT, whose bilateral forms appear to be more severe. A case-by-case approach appears better adapted. These results reinforce recommendations that suggest an early pediatric nephrologic follow-up for all newborns with a NRVT.
新生儿肾静脉血栓形成（NRVT）是一种罕见疾病，对肾功能的影响各不相同。我们报告了一项对1996年至2005年期间我院收治的9例NRVT新生儿的回顾性研究。诊断时的中位年龄为2天（范围1 - 10天）。7例患者根据一项典型临床或生物学体征怀疑诊断，并经超声确诊。7例新生儿至少有一项已知的产科或新生儿危险因素。NRVT单侧3例，双侧6例，5例合并下腔静脉血栓形成，3例合并肾上腺出血。3例患者未接受特异性治疗。诊断与特异性治疗之间的中位间隔时间为20小时（范围3 - 36小时）。3例患者接受了纤溶治疗，其中2例为双侧NRVT，2例新生儿接受了肝素治疗，1例患者接受了维生素K拮抗剂治疗。6例患者的中位评估时间为5年零2个月，5例患者肾功能完全恢复，第6个患儿有中度肾衰竭。对于NRVT，其双侧形式似乎更严重，等待随机对照研究来评估治疗对肾功能的潜在长期益处似乎是不切实际的。逐案处理的方法似乎更合适。这些结果强化了建议，即对所有NRVT新生儿进行早期儿科肾脏随访。
