Journal of General Internal Medicine

, Volume 32, Issue 11, pp 1171–1171 | Cite as

Nutcracker Syndrome and Sickle Cell Trait

  • Sean Verma
  • Mustafa Khaliqi
  • Kellee L. Oller
Letter to the Editor

To the Editors:

We read with great interest the report of an uncommon etiology of hematuria: nutcracker syndrome in a patient with sickle cell trait.1 It would be remiss to not mention renal medullary carcinoma, which may present similarly with abdominal pain and hematuria in a patient with sickle cell trait. Renal medullary carcinoma, first described in 1995, occurs almost exclusively in patients with sickle cell trait.2 Symptoms of hematuria, flank or abdominal pain, and weight loss may herald the unfortunate condition. Contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) can identify the heterogeneous infiltrative mass.3 Given the prevalence of sickle cell trait in the African American population, it is imperative to include renal medullary carcinoma in the differential diagnosis of patients presenting with hematuria.


Compliance with Ethical Standards

Conflict of Interest

The authors have no conflict of interst to disclose.


  1. 1.
    Ahmad A, McElwee SK, Kraemer RR. Nutcracker syndrome and sickle cell trait: a perfect storm for hematuria. J Gen Intern Med 2017. doi: 10.1007/s11606-017-4008-z.
  2. 2.
    Alvarez O, Rodriguez MM, Jordan L, Sarnaik S. Renal medullary carcinoma and sickle cell trait: a systematic review. Pediatr Blood Cancer 2015;62(10):1694-9. doi: 10.1002/pbc.25592.CrossRefPubMedGoogle Scholar
  3. 3.
    Shi Z, Zhuang Q, You R, Li Y, Li J, Cao D. Clinical and computed tomography imaging features of renal medullary carcinoma: a report of six cases. Oncol Lett 2016;11(1):261-6. doi: 10.3892/ol.2015.3891.PubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2017

Authors and Affiliations

  1. 1.University of South Florida Internal Medicine Residency ProgramUniversity of South FloridaTampaUSA

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