The case of nutcracker phenomenon associated with IgA nephropathy

Abstract

Introduction: The nutcracker syndrome is a rare clinical entity caused by compression of the left renal vein by the superior mesenteric artery. Epidemiologically opposite, IgA nephropathy is the most common cause of idiopathic glomerulonephritis. A combination of the two diseases has previously been reported in a few cases. Case Report: Herein we report a case of a 22-year-old male patient admitted because of macroscopic hematuria due to excessive oral anticoagulation. He had prior evidence of proteinuria, microhematuria, impaired kidney function, and enlarged left kidney. He presented with fatigue, abdominal pain, nausea, and several instances of vomiting after a meal. A diagnosis of left renal vein compression and IgA nephropathy was made based on clinical, laboratory, radiological findings and kidney biopsy. The vascular anomaly was treated conservatively, while steroids were given to treat glomerulonephritis. The result was complete regression of symptoms, normal laboratory findings, and a significant drop in proteinuria. Conclusion: It is important to evaluate whether patients have nutcracker phenomenon before initiating treatment for IgA nephropathy and vice versa, as hematuria and proteinuria can be overlapping symptoms of both conditions. Renal biopsy should not be hesitated for differential diagnosis, and treatment should be highly individualized.