Abstract
Nutcracker syndrome (NCS) is an uncommon cause of hematuria. It refers to the compression of the left renal vein between the aorta and superior mesenteric artery. It can cause both microscopic and gross hematuria. Hematuria may be associated with left flank pain. The diagnosis of NCS is often delayed. Most patients may have symptoms for many years and non-diagnostic evaluations before accurate diagnosis can be established. It should be included in the differential diagnosis of unexplained hematuria. The diagnosis and treatment of nutcracker syndrome are discussed. Conclusion: NCS is a rare but treatable clinical condition. An inclusion of this entity in the differential diagnosis of patients with unknown cause of hematuria and flank pain can achieve efficient management of this condition.
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References
Baldi S, Rabellino M, Zander T, González G, Maynar M (2011) Endovascular treatment of the nutcracker syndrome: report of two cases. Minim Invasive Ther Allied Technol 20(6):356–359
Bates CM, Adler BM, Schwaderer A, Coley BD (2007) Clinical quiz. A patient with recurrent episodes of red urine. Pediatr Nephrol 22:187–191
Beinart C, Sniderman KW, Saddekni S, Weiner M, Vaughan ED Jr, Sos TA (1982) Left renal vein hypertension: a cause of occult hematuria. Radiology 145(3):647–650
Ekim M, Ozçakar ZB, Fitoz S, Soygür T, Yüksel S, Acar B, Yalçinkaya F, Arikan N (2006) The "nutcracker phenomenon" with orthostatic proteinuria: case reports. Clin Nephrol 65(4):280–283
Gorospe EC, Aigbe MO (2006) Nutcracker syndrome: a rare cause of hematuria. Sci World J 6:745–746
Hanna HE, Santella RN, Zawada ET Jr, Masterson TE (1997) Nutcracker syndrome: an underdiagnosed cause for hematuria. S D J Med 50:429–436
Kurklinsky AK, Rooke TW (2010) Nutcracker phenomenon and nutcracker syndrome. Mayo Clin Proc 85(6):552–559
Mazzoni MB, Kottanatu L, Simonetti GD, Ragazzi M, Bianchetti MG, Fossali EF, Milani GP (2011) Renal vein obstruction and orthostatic proteinuria: a review. Nephrol Dial Transplant 26(2):562–565
Shaper KR, Jackson JE, Williams G (1994) The nutcracker syndrome: an uncommon cause of haematuria. Br J Urol 74:144–146
Shin JI, Park JM, Lee SM, Shin YH, Kim JH, Lee JS, Kim MJ (2005) Factors affecting spontaneous resolution of hematuria in childhood nutcracker syndrome. Pediatr Nephrol 20:609–613
Takemura T, Iwasa H, Yamamoto S, Hino S, Fukushima K, Isokawa S, Okada M, Yoshioka K (2000) Clinical and radiological features in four adolescents with nutcracker syndrome. Pediatr Nephrol 14:1002–1005
Venkatachalam S, Bumpus K, Kapadia SR, Gray B, Lyden S, Shishehbor MH (2011) The nutcracker syndrome. Ann Vasc Surg 25(8):1154–1164
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Waseem, M., Upadhyay, R. & Prosper, G. The nutcracker syndrome: an underrecognized cause of hematuria. Eur J Pediatr 171, 1269–1271 (2012). https://doi.org/10.1007/s00431-012-1761-1
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DOI: https://doi.org/10.1007/s00431-012-1761-1