Pediatric Nephrology

, Volume 21, Issue 11, pp 1765–1768 | Cite as

ACE inhibition can improve orthostatic proteinuria associated with nutcracker syndrome

  • Tae-Sun HaEmail author
  • Eun-Ju Lee
Brief Report


Left renal vein entrapment syndrome (nutcracker syndrome) was documented by magnetic resonance angiography (MRA) as a cause of orthostatic proteinuria in a 14-year-old girl female adolescent. Because of continuous proteinuria we performed a left renal biopsy which showed moderate mesangial hypercellularity. Her overt orthostatic proteinuria disappeared after a treatment of angiotensin-converting enzyme (ACE) inhibition. Nutcracker syndrome remains a rare but important cause of elevated protein excretion, which can induce mesangial changes and be improved by ACE inhibitor treatment.


ACE inhibition Mesangial hypercellularity Nutcracker syndrome Orthostatic proteinuria 


  1. 1.
    Takahashi Y, Shintaku N (1991) Left renal vein entrapment. Pediatr Nephrol 5:368–369CrossRefGoogle Scholar
  2. 2.
    Stewart BH, Reiman G (1982) Left renal venous hypertensive nutcracker syndrome. Managed by direct renocaval reimplantation. Urology 20:365–369CrossRefGoogle Scholar
  3. 3.
    Shintaku N, Takahashi Y, Akaishi K, Sano A, Kuroda Y (1990) Entrapment of left renal vein in children with orthostatic proteinuria. Pediatr Nephrol 4:324–327CrossRefGoogle Scholar
  4. 4.
    Lee SJ, You ES, Lee JE, Chung EC (1997) Left renal vein entrapment syndrome in two girls with orthostatic proteinuria. Pediatr Nephrol 11:218–220CrossRefGoogle Scholar
  5. 5.
    Springberg PD, Garret LE, Thompson AL, Collins NF, Lordon RE, Robinson KR (1982) Fixed and reproducible orthostatic proteinuria: results of a 20 year follow-up study. Ann Intern Med 97:516–519CrossRefGoogle Scholar
  6. 6.
    Robinson RR, Ashworth CT, Glover SM, Phillippi PF, Lecocq FR, Langelier PR (1961) Fixed and reproducible orthostatic proteinuria. I. Light microscopic studies of the kidney. Am J Pathol 39:291–301PubMedPubMedCentralGoogle Scholar
  7. 7.
    Buchanec J, Kliment J, Javorka K, Belakova S (1983) X-ray changes in the kidneys of children with orthostatic proteinuria. Int Urol Nephrol 15:3–9CrossRefGoogle Scholar
  8. 8.
    Vehaskari VM (1990) Mechanism of orthostatic proteinuria. Pediatr Nephrol 4:328–330CrossRefGoogle Scholar
  9. 9.
    Yoshioka T, Mitarai T, Kon V, Deen WM, Rennke HG, Ichikawa I (1986) Role of angiotensin II in an overt functional proteinuria. Kidney Int 30:538–545CrossRefGoogle Scholar
  10. 10.
    Yoshioka T, Rennke HG, Salant DJ, Deen WM, Ichikawa I (1987) Role of abnormally high transmural pressure in the permselectivity defect of glomerular capillary wall: a study in early passive Heymann nephritis. Circ Res 61:531–538CrossRefGoogle Scholar
  11. 11.
    Remuzzi G, Bertani T (1998) Pathophysiology of progressive nephropathies. N Engl J Med 339:1448–1456CrossRefGoogle Scholar
  12. 12.
    Aros C, Remuzzi G (2002) The renin-angiotensin system in progression, remission and regression of chronic nephropathies. J Hyperten 20[Suppl 3]:S45–S53Google Scholar
  13. 13.
    Ruiz-Ortega M, Lorenzo O, Suzuki Y, Ruperez M, Egido J (2001) Pro-inflammatory actions of angiotensins. Curr Opin Nephrol Hypertens 10:321–329CrossRefGoogle Scholar
  14. 14.
    Keane WF, Raij L (1985) Relationship among altered glomerular barrier permselectivity, angiotensin II, and mesangial uptake of macromolecules. Lab Invest 52:599–604PubMedGoogle Scholar

Copyright information

© IPNA 2006

Authors and Affiliations

  1. 1.Department of PediatricsChungbuk National University HospitalCheongju, ChungbukSouth Korea

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