Renal vein thrombosis (RVT) affects 1.3-2.2/100,000 newborns. The classical presenting triad includes gross haematuria, thrombocytopenia and palpable abdominal mass. RVT can appear due to low-flow intrarenal circulation or umbilical vein catheterization. Perinatal factors like asphyxia, hypovolemia or shock and prothrombotic disorders have also been described as predisposing factors for spontaneous RVT. Although treatment is controversial, thrombolysis has been suggested for extensive cases with bilateral involvement. We present a case of a neonate with extensive bilateral renal vein and inferior cava vein thrombosis who was managed with heparin therapy.