A Child With Recurrent Gross Hematuria Caused by the Nutcracker Syndrome

Effectiveness of supine/standing urinalysis for differential diagnosis of left renal vein entrapment syndrome combined with or without glomerulopathy

“…In 1972, De Schepper first described nutcracker syndrome, resulting from the compression of the LRV between the aorta and the SMA, with symptomatic presentation . Since then, the syndrome has been recognized as a valid clinical entity causing diverse symptoms, among which abnormal urinalysis including haematuria and/or proteinuria is the chief complaint that drives patients to the department of nephrology for diagnosis and treatment. In our study, most of the patients enrolled were adolescents with low BMI; we therefore suggest that LRVES should be excluded first in patients with these characteristics.…”

“…Left renal vein entrapment syndrome (LRVES), also known as nutcracker syndrome, resulting from compression of the LRV between the abdominal aorta (A0) and the superior mesenteric artery (SMA) (Fig. ), manifests as a wide spectrum of symptoms, including haematuria and proteinuria, pain or gonadal vein syndrome, and varicoceles . It has been reported that LRVES could exist with or without glomerulopathy such as IgA nephropathy .…”

Diagnostic Value of Renal Doppler Ultrasonography for Detecting Nutcracker Syndrome in Children With Recurrent Gross Hematuria

“…We read with great interest the recent contribution by Jodorkovsky et al 1 They reported a 10-year-old boy with recurrent gross hematuria who underwent a cystoscopy and a renal biopsy to evaluate its glomerular and extraglomerular causes, and nutcracker syndrome (NS) was diagnosed later by magnetic resonance angiography. They emphasized an increased awareness of the NS to avoid unnecessary invasive procedures.…”

“…Second, although renal venography combined with measurement of the pressure gradient between the inferior vena cava and LRV has been introduced to be the most accurate tool to diagnose NS, 1,3 it is an invasive and time-consuming procedure. In the case of Jodorkovsky et al, 1 NS was diagnosed by magnetic resonance angiography, which is too expensive.…”

“…Second, although renal venography combined with measurement of the pressure gradient between the inferior vena cava and LRV has been introduced to be the most accurate tool to diagnose NS, 1,3 it is an invasive and time-consuming procedure. In the case of Jodorkovsky et al, 1 NS was diagnosed by magnetic resonance angiography, which is too expensive. However, Doppler sonographic findings were comparable to venographic findings, and the sensitivity and specificity of the PV2/PV1 ratios were higher than those of the ratio of LRV diameters (sensitivity 80% vs 69%; specificity 94% vs 89%) in adults with NS.…”