On day 21, the baby became lethargy but afebrile, accompanying with nonbilious vomiting and blood clot in urine. Blood culture and the tip culture of right femoral catheter were negative. The complete blood count showed leukocytosis (white blood cell = 32,000/μL) and thrombocytopenia (platelet = 99,000/μL). C-reactive protein was 10.2 mg/L. Serum creatinine and blood urea nitrogen concentrations were normal. Urine sediments revealed red blood cell count to be 340 (normal <20/μL). The renal ultrasound scan ( Fig. 1) showed marked enlargement of left kidney with anechoic cyst-like lesion over the left suprarenal area, compatible with adrenal hemorrhage. find more The left kidney became echogenic

with prominent echobright intermedullary streaks. Abdominal computed tomographic (CT) scan ( Fig. 2) revealed left RVT extending to inferior vena cava (IVC), in addition to left adrenal hemorrhage. Hypertension with systolic blood pressure (BP) >100 mm Hg occurred 3 days later, which gradually subsided after 4 days of hydralazine usage.

At 36th day of age, repeat ultrasonography showed that left kidney returned to normal size, and left adrenal hemorrhage was in regression. No azotemia happened during this period. The patient was discharged 6 weeks later. The condition of the patient was rather stable with normal BP when followed up in the outpatient department KU-55933 cell line at age 6 months. Serial follow-up of renal echo showed left kidney atrophy. Follow-up CT angiography 3 months Florfenicol later revealed small contracted left kidney with poor function and nonvisualization of left renal vein. The incidence of RVT in term neonates based on clinical data is estimated at 2.2/100,000 live births. There is a 6-fold higher rate in preterm infants, which may accounts for one half of neonate cases. In up to 30% of cases, RVT extends to the IVC. In about 10%, it is associated

with adrenal hemorrhage.1 The epidemiologic database of neonatal RVT in Taiwan shows lack of information. Acquired risk factors that have been described in association with neonatal RVT include catheters insertion, asphyxia, dehydration, shock, sepsis, surgery, trauma, and infants of diabetic mothers. Application of a central venous line plays the most important role.2 In our case, elevated BP and gross hematuria seemed to be the first sign to notify the clinician. In another report, 11 of 12 newborns with hypertension had renovascular disease. BP became normal with therapy and remained normal after discontinuation of treatment. During follow-up at a mean age of 5.75 years, scans remained abnormal, and 5 patients had unilateral renal atrophy.3 In this case, the follow-up renal echo 15 days after gross hematuria revealed that the kidney size recovered; nevertheless, it is necessary to arrange long-term follow-up because some focal scaring or atrophic kidney has been reported.