Gross hematuria of uncommon origin: The nutcracker syndrome

Russo, Domenico; Minutolo, Roberto; Iaccarino, Vittorio; Andreucci, Michele; Capuano, Alfredo; Savino, Francesco A.

doi:10.1053/ajkd.1998.v32.pm10074588

Cited by 55 publications

(51 citation statements)

References 8 publications

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“…Idiopathic renal bleeding and massive orthostatic proteinuria are seen in 18% and 14% of patients, respectively, 5 and are caused by lysis of red blood cells in the urine. 67 Degrees of proteinuria vary depending on postural changes. 43 Chronic fatigue syndrome and fatigue symptoms have been associated with NCS with high LRV-IVC pressure gradients.…”

Section: Clinical Featuresmentioning

confidence: 99%

“…28,33,79-82 Cases of Henoch-Schonlein purpura, 83 IgA nephropathy, 84,85 membranous nephropathy, 67 and idiopathic hypercalciuria with urolithiasis 86 concurrent with NCS have been described. Combined NCS and Dumbar syndrome (also known as median arcuate ligament syndrome) has been reported.…”

Section: Clinical Featuresmentioning

confidence: 99%

“…35,84 In cases of hematuria, the number of isomorphic erythrocytes, suggesting nonglomerular origin, may be variable, and this finding is unreliable. 67,[102][103][104] Historically, a number of imaging methods have been used: renal angiography, angiographic CT, 17,21,24 digital subtraction angiography, 35 standard magnetic resonance (MR) imaging, 23 and MR angiography (Figure 2 and Figure 3). 18,23,100,105,106 Renal angiography shows delayed venous washout from the left kidney.…”

Section: Normal Anatomic and Physiologic Findingsmentioning

confidence: 99%

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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%

Section: Clinical Featuresmentioning

confidence: 99%

Section: Normal Anatomic and Physiologic Findingsmentioning

confidence: 99%

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Nutcracker Phenomenon and Nutcracker Syndrome

Kurklinsky¹,

Rooke

2010

Mayo Clinic Proceedings

455

586

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“…The compression of the LRV in the fork between the abdominal aorta and proximal superior mesenteric artery causes left renal venous hypertension, which subsequently leads to the development of collateral veins with intrarenal and perirenal varicosities, and may result in several signs and symptoms such as pain in the flanks, hematuria, left varicocele, fatigue, proteinuria, pelvic congestion [6,7].…”

Section: Discussionmentioning

confidence: 99%

Left Varicocele Revealing a Nutcracker Syndrome: A Case Report and Review of Literature

Bote¹,

Ziouani²,

Alaoui³

et al. 2017

AJMCR

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Nutcracker syndrome (NCS) is a rare entity defined by the symptomatic hypertension of the left renal vein (LRV) compressed in the majority of cases between the superior mesenteric artery and the aorta. Hematuria, pelvic or back pain and left varicocele are the most commonly symptoms. Doppler ultrasound, computed tomography (CT) and selective left renal vein phlebography are useful to confirm the diagnosis. Treatment criteria are not well established, however for asymptomatic patients with no haematuria, the treatment remains conservative. We report the case of a 17-year-old man, with an intermittent left flank pain for 4 years and increasing volume of the left testicle for 8 months.

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“…The renal ultrasound and CTA results indicated this manifestation as NCP. Compared to invasive procedure left renal retrograde venography, non invasive examinations such as Doppler ultrasonography and CTA remain the main procedures to final diagnosis of NCP [4] [5] [6]. Our patient was conservatively observed without any anti-hypertensive drugs and be asked for putting on weight appropriately.…”

Section: Case Reportmentioning

confidence: 99%

An Incidental Detection of Nutcracker Phenomenon in an Adolescent with Transient High Blood Pressure: A Case Report

Min¹,

Chen²,

Wang³

et al. 2016

CRCM

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Nutcracker phenomenon (NCP) is caused by a compression of left renal vein between aorta and superior mesenteric artery. The traditional clinical manifestations of nutcracker syndrome is usually accompanied with abdominal pain, hematuria, orthostatic proteinuria, and varicocele formation, however, hypertension is rarely reported as main clinical feature. We describe a male adolescent with manifestation of hypertension who was identified as NCP. Renal ultrasound and computed tomography angiography have provided evidences of left renal vein dilatation, probably due to the compression through the decreased angle between aorta and superior mesenteric artery. There were no other signs for secondary hypertension for the blood levels of renin and aldosterone being between normal limits and urinalysis being negative of hematuria and proteinuria. This patient was conservatively observed without any anti-hypertensive drugs and was asked for appropriately putting on weight. Three months later, the hypertension symptom was alleviated. In conclusion, although there were no established direct pathogenetic links between hypertension and NCP, no other definite etiology was shown to be the cause of this main manifestation. Thus we speculate that the NCP might be the main cause of hypertension in this patient.

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Gross hematuria of uncommon origin: The nutcracker syndrome

Cited by 55 publications

References 8 publications

Nutcracker Phenomenon and Nutcracker Syndrome

Nutcracker Phenomenon and Nutcracker Syndrome

Left Varicocele Revealing a Nutcracker Syndrome: A Case Report and Review of Literature

An Incidental Detection of Nutcracker Phenomenon in an Adolescent with Transient High Blood Pressure: A Case Report

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