Spontaneous remission of persistent severe hematuria in an adolescent with nutcracker syndrome: seven years? observation

Tanaka, Hiroshi; Waga, Shinobu

doi:10.1007/s10157-003-0267-6

Cited by 61 publications

(40 citation statements)

References 7 publications

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“…Recently, Tanaka et al described an adolescent with nutcracker syndrome who showed spontaneous remission of persistent severe hematuria after 7 years' observation, and suggested that his good physical development, especially the increase in height, might be the cause of the spontaneous remission of the disease [7]. We were interested in this point and investigated the natural course and outcome of nutcracker syndrome using Doppler US.…”

Section: Discussionmentioning

confidence: 97%

“…Recently, Tanaka et al reported that spontaneous remission of persistent severe hematuria occurred in an adolescent with nutcracker syndrome after 7 years' observation, and suggested that his good physical development might change the presumptive hemodynamic factors [7]. The purpose of this study was to identify factors affecting spontaneous resolution of hematuria in children with nutcracker syndrome.…”

Section: Introductionmentioning

confidence: 97%

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Factors affecting spontaneous resolution of hematuria in childhood nutcracker syndrome

et al. 2005

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To identify factors affecting spontaneous resolution of hematuria in children with nutcracker syndrome, 20 patients diagnosed as having nutcracker syndrome using renal Doppler ultrasound (US) were analyzed retrospectively. Sixteen patients had microscopic hematuria, and four had gross hematuria at presentation. The mean age was 10.6 years (range 2.5-14 years). All underwent a follow-up Doppler US examination after a mean period of 1.4 years (range 0.5-3.5 years) after the first US was performed, and height and weight were measured at the time of US. At the time of follow-up US, hematuria disappeared in 15 patients and improved in 3. The peak velocity (PV) ratios of the left renal vein (LRV) at the follow-up US decreased significantly when compared to the first US examination (7.74+/-2.64 vs 3.50+/-1.09, p<0.0001), and height (147.4+/-20.1 vs 152.3+/-18.8 cm) and weight (36.1+/-10.9 vs 42.3+/-12.7 kg) increased (p<0.0001). Changes in the PV ratios of the LRV correlated positively with changes in the PV at the aortomesenteric portion (r=0.569, p=0.009). Changes in the PV at the aortomesenteric portion correlated negatively with changes in body mass index (BMI) (r=-0.543, p=0.013). Although spontaneous resolution of hematuria in children with nutcracker syndrome is obscure, our findings suggest the increase in BMI may be a possible hemodynamic factor.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 97%

Factors affecting spontaneous resolution of hematuria in childhood nutcracker syndrome

et al. 2005

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“…year-old patient in whom spells of gross hematuria did not remit until 4 years after diagnosis [7]. Invasive procedures such as stenting or surgical correction are usually reserved for patients with intractable pain or significant episodes of blood loss requiring transfusions [2,3,20].…”

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confidence: 99%

“…In males, back pressure into the left gonadal vein may also lead to a left-sided varicocele [1][2][3]. Children and adolescents with Nutcracker syndrome usually develop hematuria like adults [5][6][7][8], but may also present with orthostatic proteinuria [9] or intussusception [10].…”

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confidence: 99%

A patient with recurrent episodes of red urine: answer

et al. 2007

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Due to the presence of intermittent recurrent gross hematuria after physical activity accompanied with left-side lower back pain, the most likely diagnosis was a structural renal abnormality such as polycystic or horseshoe kidneys. While renal calculi could also be consistent with the patient's presentation, the urine-calcium-to-creatinine ratio was normal. The absence of proteinuria or hematuria between episodes as well as the absence of red blood cell casts made a glomerular etiology such as IgA nephropathy unlikely.To evaluate for anatomical abnormalities, an abdominal computed tomography (CT) scan with an intravenous power injection of non-ionic contrast was obtained. The CT scan revealed normal-appearing kidneys, however, the left renal vein was significantly narrowed as it coursed between the superior mesenteric artery and the aorta (see Fig. 1). Collateral venous drainage was also noted along the paraspinal veins on the left side (see Fig. 1). Approximately 3 weeks later, a renal ultrasound with venous Doppler sonography determined that the kidneys were normal in size, shape, and echo-texture and that the left proximal renal vein appeared dilated. Venous waveforms in the proximal left, the distal left, and the right renal veins were of equal amplitude. In addition, no collateral veins were described. A few hours after the Doppler ultrasound test, left renal venography demonstrated stenosis at the superior mesenteric artery and the presence of collateral hemiazygous and paralumbar vessels (see Fig. 2). In addition, while the mean pressure in the proximal left renal vein was 15 mm Hg, the pressures at the left renal vein ostium and the inferior vena cava (IVC) were 7 and 8 mm Hg, respectively. The gradient between the proximal left renal vein and the ostium and IVC confirmed the diagnosis of Nutcracker syndrome.After making the diagnosis, the patient was advised to limit physical activities that caused severe pain. With conservative management over the next 2-3 months after the venography, the patient had a gradual decrease in the number of episodes of gross hematuria and the left-sided "catching sensation." For the next 2.5 years since then, he has been asymptomatic. CommentaryNutcracker syndrome, a rare cause of hematuria, occurs when the left renal vein becomes entrapped between the This refers to the article that can be found at http://dx.

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“…7 schlanke (asthenische) Kinder bzw Jugendliche. Es liegen Studien vor, in denen durch Gewichtszunahme ein Sistieren des Nut crackerPhänomens beobachtet wurde[11]. Patient eine Einschränkung der Nierenfunktion, eine Proteinurie oder z.…”

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Hämaturie im Kindesalter

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Spontaneous remission of persistent severe hematuria in an adolescent with nutcracker syndrome: seven years? observation

Cited by 61 publications

References 7 publications

Factors affecting spontaneous resolution of hematuria in childhood nutcracker syndrome

Factors affecting spontaneous resolution of hematuria in childhood nutcracker syndrome

A patient with recurrent episodes of red urine: answer

Hämaturie im Kindesalter

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