Abstract
Nutcracker syndrome (NS) refers to compression of the left renal vein between the aorta and the superior mesenteric artery which results in left renal venous hypertension. The typical clinical presenting feature is hematuria. In this report we describe the case of patient with a single kidney who developed severe proteinuria due to NS. She was successfully treated with left renal vein transposition. This case clearly shows the relation between NS and severe proteinuria based on normal biopsy findings and the complete disappearance of proteinuria following surgery.
References
De Schepper A (1972) Nutcracker phenomenon of the renal vein causing left renal vein pathology. J Belg Radiol 55:507–511
Shokeir AA, El-Diatsi TA, Ghoneim MA (1994) The nut-cracker syndrome: new methods of diagnosis and treatment. Br J Urol 74:139–143
Shintaku N, Takahashi Y, Akaishi K, Sano A, Kuroda Y (1990) Entrapment of left renal vein in children with orthostatic proteinuria. Pediatr Nephrol 4:324–327
Lee SJ, You ES, Lee JE, Chung EC (1997) Left renal vein entrapment syndrome in two girls with orthostatic proteinuria. Pediatr Nephrol 11:218–220
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 65:280–283
Ahmed K, Sampath R, Khan MS (2006) Current trends in the diagnosis and management of renal nutcracker syndrome. Eur J Vasc Endovasc Surg 31:410–416
El Sadr AR, Mina A (1950) Anatomical and surgical aspects in the operative management of varicoceles. Urol Cut Rev 54:257–262
Menard MT (2009) Nutcracker syndrome: When should it be treated and how? Perspect Vasc Surg Endovas Ther 21:117–124
Fitoz S, Ekim M, Özçakar ZB, Elhan AH, Yalçınkaya F (2007) Nutcracker syndrome in children: The role of upright position examination and superior mesenteric artery angle measurement in the diagnosis. J Ultrasound Med 26:573–580
Faizan MK, Finn LS, Paladin AM, McDonald RA (2002) A 14-year-old girl with recumbent proteinuria. Pediatr Nephrol 17:379–381
Yoshioka T, Mitarai T, Kon V, Deen WM, Renne HG, Ichikawa I (1986) Role of angiotensin II in an overt functional proteinuria. Kidney Int 30:538–545
Ha TS, Lee EJ (2006) ACE inhibition can improve orthostatic proteinuria associated with nutcracker syndrome. Pediatr Nephrol 21:1765–1768
Tanaka H, Waga S (2004) Spontaneous remission of persistent severe hematuria in an adolescent with nutcracker syndrome: seven years’ observation. Clin Exp Nephrol 8:68–70
Milani GP, Mazzoni MBM, Burdick L, Bianchetti MG, Fossali EF (2010) Postural proteinuria associated with left renal vein entrapment: A follow up evaluation. Am J Kidney Dis 55:e29–e31
Wang L, Yi L, Yang L, Liu Z, Rao J, Liu L, Yang J (2009) Diagnosis and surgical treatment of nutcracker syndrome: A single-center experience. Urology 73:871–876
Basile A, Tsetis D, Calcara G, Figuera M, Patti MT, Ettorre GC, Granata A (2007) Percutaneous nitinol stent implantation in the treatment of nutcracker syndrome in young adults. J Vasc Interv Radiol 18:1042–1046
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Özçakar, Z.B., Yalçınkaya, F., Fitöz, S. et al. Nutcracker syndrome manifesting with severe proteinuria: a challenging scenario in a single-kidney patient. Pediatr Nephrol 26, 987–990 (2011). https://doi.org/10.1007/s00467-011-1793-1
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DOI: https://doi.org/10.1007/s00467-011-1793-1