Renal venous thrombosis in the new-born.

Thrombosis of the renal vein was first described by Rayer in 1837. This was followed in 1877 by Hutinel's account of forty-two cases of renal thrombosis, in thirty of which the condition was bilateral. Abeshouse (1945), in reviewing 228 cases of renal thrombosis of all varieties, found ninetyeight of these in children less than a year old, and of this total ninety occurred in infants during the first two months of life. Barenburg et al. (1941) reported five cases in a series of twenty-five necropsies carried out on infants with gastroenteritis-a figure which suggests a rather bigh incidence in this selected group of cases. At the Birmingham Children's Hospital over a period of five years and out of a total of 1,430 routine postmortem examinations, six instances of renal haemorrhagic infarction were found. In four of these cases the main renal trunk was thrombosed. In the remaining two cases the thrombosis was confined to the interlobular veins and was therefore detected only on microscopic examination (figs. I and 3). A survey of the literature was made by Morison in 1945, with particular reference to renal thrombosis and infarction in the newborn, and he includes a description of a series of fatal cases. Renal thrombosis may be primary, that is, the thrombotic process originates within the renal venous system; or secondary, resulting from extension of a thrombus along the vena cava or tributaries of the renal vein. This latter variety is rare in childhood. Sandblom (1948) has further subdivided the cases arising during the neonatal period. 1. A primary, rare form with no obvious etiolcgy, and predominating urinary symptoms. 2. The usual variety encountered in infancy, which is secondary to infection with dehydraticn, and in which the urinary chapges are minimal. Ante-mortem diagncsis cf the condition is rare, due probably to the rapid dissolution which almost invariably follows the onset of symptoms. A case of unilateral thrombosis, of his first type, was described by Sandblom (1948), in which nephrectomy appeared to be a life-saving measure in a five-day-old infant. Campbell and Matthews (1942) had previously described two similar cases with recovery following nephrectomy. One of these was unique in that a correct pre-operative diagnosis was made. So far as can be ascertained, there is no authentic account in the literature of survival following bilateral renal venous thrombosis. Such a case is here recorded, with the notes of two fatal cases.