Acute Pyelonephritis: The clot unfolds

We report a case of Renal Vein Thrombosis (RVT) thought to be a complication of actue pyelonephritis in a 44 year old female presenting to the acute medical take. The most common cause of RVT is nephrotic syndrome, due to a hyper-coaguable state. RVT is also seen in renal cell carcinoma due to tumour invasion. A possible theory relating RVT to acute pyelonephritis may relate to concomitant thrombophlebitis of the renal vein in pyelonephritis, which then predisposes to thrombosis. The patient was subsequently investigated for possible causes of this thrombotic event and anticoagulated. The management of RVT is also discussed. We hope this case highlights the importance of keeping an open mind and adding to the original management when a new, but unexpected finding is made.