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Newly-identified symptoms of left renal vein entrapment syndrome mimicking orthostatic disturbance

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Abstract

Background

In addition to the urinary abnormalities, symptoms of left renal vein entrapment between the aorta and superior mesenteric artery (left renal vein entrapment syndrome, LRVES) may include abdominal and flank pain as well as chronic fatigue. We investigated various LRVES symptoms in this study.

Methods

In 53 pediatric LRVES patients treated at our department, 22 had a score of 5 points or higher on orthostasis. Initial evaluation of LRVES by abdominal ultrasonography showed a stenotic-to-prestenotic vein diameter ratio of 0.2 or less. Definitive diagnosis was made by computed tomography and magnetic resonance angiography. Cortisol, catecholamine (CA), and brain natriuretic peptide (BNP) were also measured.

Results

The frequency of LRVES was 2.5 times higher in girls than in boys. Low or very low body mass indexes were seen in both sexes. The most common initial finding was urine abnormalities, followed by dizziness and malaise. In 6 patients, orthostasis precluded school attendance. Ten patients had orthostasis scores above 12. Patients unable to attend school had either low levels of plasma or urinary cortisol. Midodrine significantly decreased orthostasis scores. Some patients required treatment with fludrocortisone. Plasma CA, renin, and BNP levels were all normal.

Conclusions

Locally excessive venous pressure may cause reversible adrenal dysfunction with transitory Addisonian symptoms. Children with cryptogenic malaise or severe orthostasis should be evaluated for LRVES.

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Authors and Affiliations

  1. Department of Pediatrics, Kinki University School of Medicine, Osaka, Japan

    Machiko Koshimichi, Keisuke Sugimoto, Hidehiko Yanagida, Shinsuke Fujita, Tomoki Miyazawa, Naoki Sakata, Mitsuru Okada & Tsukasa Takemura

  2. Department of Pediatrics, Kinki University School of Medicine, 377-2 Ohno-higashi, Osaka-Sayama, 589-8511, Japan

    Tsukasa Takemura

Authors
  1. Machiko Koshimichi
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  2. Keisuke Sugimoto
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  3. Hidehiko Yanagida
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  4. Shinsuke Fujita
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  5. Tomoki Miyazawa
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  6. Naoki Sakata
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  7. Mitsuru Okada
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  8. Tsukasa Takemura
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Correspondence to Tsukasa Takemura.

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Koshimichi, M., Sugimoto, K., Yanagida, H. et al. Newly-identified symptoms of left renal vein entrapment syndrome mimicking orthostatic disturbance. World J Pediatr 8, 116–122 (2012). https://doi.org/10.1007/s12519-012-0349-1

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  • DOI: https://doi.org/10.1007/s12519-012-0349-1

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