Abnormalities of Renal Venous System and Unexplained Renal Hematuria

Hayashi, Mutsuo; Kume, Takashi; Nihira, Hiromi

doi:10.1016/s0022-5347(17)55268-4

Cited by 60 publications

(26 citation statements)

References 11 publications

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“…[48][49][50] It varies from microhematuria to macrohematuria, occasionally with resultant anemia that requires blood transfusions. 3,[50][51][52][53][54][55] Cystoscopy may identify a left ureteral origin. 22,24,50,56,57 In a study by Shin et al, 30 the causes of isolated hematuria could not be identified by routine methods in 69% of pediatric cases.…”

Section: Clinical Featuresmentioning

confidence: 99%

Nutcracker Phenomenon and Nutcracker Syndrome

Kurklinsky¹,

Rooke

2010

Mayo Clinic Proceedings

455

586

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N utcracker phenomenon (NCP), also known as left renal vein entrapment,1-3 is characterized by impeded outflow from the left renal vein (LRV) into the inferior vena cava (IVC) due to extrinsic LRV compression, often accompanied by demonstrable lateral (hilar) dilatation and medial (mesoaortic) narrowing (schematic representation of NCP/ nutcracker syndrome [NCS] in Figure 1). Although the terms nutcracker syndrome and nutcracker phenomenon are sometimes used interchangeably in the literature, Shin and Lee 4 emphasize that the nutcracker anatomy is not always associated with clinical symptoms and that some of the anatomic findings suggestive of nutcracker may represent a normal variant or be accounted for by other conditions. Therefore, the term nutcracker syndrome should be reserved for patients with characteristic clinical symptoms associated with demonstrable nutcracker morphologic features. No consensus exists on what symptoms are severe enough to warrant the designation of a clinical syndrome or to what extent various findings may simply reflect different evolutionary stages of the process. Because of these uncertainties, some authors focus on the characteristic anatomic and hemodynamic findings, referring to them as NCP rather than NCS. 5Nutcracker phenomenon refers to compression of the left renal vein, most commonly between the aorta and the superior mesenteric artery, with impaired blood outflow often accompanied by distention of the distal portion of the vein. The nutcracker syndrome (NCS) is the clinical equivalent of nutcracker phenomenon characterized by a complex of symptoms with substantial variations. Depending on specific manifestations, NCS may be encountered by different medical specialists. Although it may be associated with substantial morbidity, the diagnosis of NCS is often difficult and is commonly delayed. Diagnostic and treatment criteria are not well established, and the natural history of NCS is not well understood. We performed an initial review of the literature through MEDLINE, searching from 1950 to date and using the keywords nutcracker syndrome, nutcracker phenomenon, and renal vein entrapment. We performed additional reviews based on the literature citations of the identified articles. We attempted to elucidate clinical relevance of these conditions and their prominent features and to summarize professional experience. Mayo Clin

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Section: Clinical Featuresmentioning

confidence: 99%

Nutcracker Phenomenon and Nutcracker Syndrome

Kurklinsky¹,

Rooke

2010

Mayo Clinic Proceedings

455

586

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“…Mitty and Goldman [ 15] report this finding in 2 children aged 5 and 6 years, Hayaski et al [16] in a child of 10 years, but Di Lanoet al [14] did not find it in patients below the age of 14 years. Ingelfinger et al [2] in their review of 128 children with gross hematuria did not report any patients with this problem.…”

Section: Discussionmentioning

confidence: 93%

“…Both lead an active lifestyle with no limitations. The decision to follow these patients conservatively seems appropriate, since the well-being of patients appears no different than those subjected to sur gical excision or vascular reconstruction [16][17][18].…”

Section: Discussionmentioning

confidence: 99%

Idiopathic Unilateral Gross Hematuria in the Pediatric Patient

Wolfish¹,

McLaine²

1985

Am J Nephrol

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Microscopic hematuria is not an uncommon finding in the pediatric population. Since gross hematuria elicits parental and physician concern, its presence may result in extensive investigation. Unilateral hematuria is an unusual feature of gross hematuria, particularly in the pediatric patient. Although a number of structural and pathologic entities have been described to account for the laterality, in the majority of instances no overt underlying process has been uncovered. Unilateral hematuria appears to be benign, idiopathic, and has a prognosis no different than other idiopathic hematurias in the pediatric age group.

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“…Only few cases showing clinical symptoms with this anomaly have been reported in the literature [8,13,14,17,26]. Satyapal et al [21] reported no symptomatic patients, proclaiming that all renal vein variations are clinically silent and remain unnoticed until discovered during venography, operation or autopsy.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Incidence of Clinical Symptoms of the Retroaortic Left Renal Vein

Heidler

Hruby²,

Schwarz³

et al. 2015

Urol Int

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Objective: To analyze the prevalence and incidence of clinical symptoms of retroaortic left renal vein (RLRV) diagnosed incidentally over 10 years by computed tomography (CT). Patients and Methods: 7,929 consecutive patients (out- and inpatients) were studied with multidetector CT from January 2000 to April 2011. We retrospectively reviewed RLRV patients' medical records and analyzed their clinical characteristics. Results: A total of 61 out of 7,929 patients had a RLRV, therefore the prevalence was 0.77%. Only 4 of 61 (6.6%) RLRV patients diagnosed by CT scan were clinically symptomatic. RLRV was associated with flank pain and microhematuria in one patient (1.6%), in another one with microhematuria only and in one with ureteropelvic junction obstruction. Furthermore, one patient suffered from arterial hypertension associated with a RLRV. Conclusions: RLRV is a rare finding, and only a small minority of RLRVs causes symptoms.

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Abnormalities of Renal Venous System and Unexplained Renal Hematuria

Cited by 60 publications

References 11 publications

Nutcracker Phenomenon and Nutcracker Syndrome

Nutcracker Phenomenon and Nutcracker Syndrome

Idiopathic Unilateral Gross Hematuria in the Pediatric Patient

Prevalence and Incidence of Clinical Symptoms of the Retroaortic Left Renal Vein

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