Nephro urology case
The Nutcracker Syndrome (NS) originates from the compression of the left renal vein in its trajectory, mostly between the aorta and the superior mesenteric artery, or less frequently between the aorta and the lumbar spine. Although asymptomatic in most cases, it can be a rare cause of hematuria.
We present the case of an 11-year-old male adolescent who was referred to a Pediatric Nephrology evaluation for a two-month-long gross hematuria. The patient also had anemia without hemodynamic repercussion. After the initial work-up, it was concluded to be a non-glomerular, extra-renal hematuria. Abdominal and renal ultrasound with Doppler was normal. The abdominal and pelvic computerized angiotomography revealed, after a careful examination, the presence of NS. Due to persistent gross hematuria with the need for transfusional support, at the age 13, the patient underwent a renal autotransplantation.
The diagnosis of NS is essentially clinical, imagiological and necessarily a diagnosis of exclusion. The treatment must be individualized and requires a multifactorial approach.
Sousa B, Tavares M, Braga A, Vieira A, Mariz C, Freitas A, et al. Síndrome de nutcracker como causa de hematúria recorrente. Acta Pediatr Port 2002; 33:441-4.
Calado R, Braz M, Lobo L, Simão C. Síndrome de nutcracker: Hematúria sem diagnóstico? Acta Med Port 2011; 24:695-8.
Ahmed K, Sampath R, Khan MS. Current trends in the diagnosis and management of renal nutcracker syndrome: A review. Eur J Vasc Endovasc Surg 2006; 31:410-6.
Teixeira E, Machado M, Grilo E, Moreira A, Cordinhã C, Carmo C, et al. Síndrome de Nutcraker: Um diagnóstico a Evocar. Acta Pediatr Port 2016; 47:182-6.
Barka M, Mallat F, Hmida W, Chavey SO, Ahmed KB, Abdallah AB, et al. Posterior nutcracker syndrome with left renal vein duplication as a cause of gross hematuria and recurrent left varicocelo in an eight-year-old boy. Int J Case Rep Images 2014 ;5:572-5.
Kurklinsky AK, Rooke TW. Nutcracker phenomenon and nutcracker syndrome. Mayo Clin Proc 2010; 85:552-9.
Machado M, Machado R, Mendes D, Almeida R. May-Thurner syndrome associated with a nutcracker syndrome, clinical case and literature review. Angiologia e Cirurgia Vascular. 2017; 2: 52-6.
Copyright (c) 2018 NASCER E CRESCER - BIRTH AND GROWTH MEDICAL JOURNAL
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright and access
This journal offers immediate free access to its content, following the principle that providing free scientific knowledge to the public provides greater global democratization of knowledge.
The works are licensed under a Creative Commons Attribution Non-commercial 4.0 International license.
Nascer e Crescer – Birth and Growth Medical Journal do not charge any submission or processing fee to the articles submitted.