nutcracker syndrome


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nutcracker syndrome

nonglomerular hematuria due to compression of the left renal vein between the aorta and superior mesenteric artery; renal hilar varices, collateral veins, and proteinuria may be found. See: nutcracker.
A rare clinical complex which occurs in relatively young and previously healthy people, which is characterised by compression of the left renal vein (LRV) between the aorta and superior mesenteric artery (SMA), fancifully likened to the effect of a nutcracker, with the aorta and SMA each corresponding to an arm of the nutcracker and the LRV to the nut itself. The squeezing can lead to left renal vein hypertension, resulting in rupture of the thin walled vein into the renal calyceal fornix
Diagnosis Left renal venography—gold standard test, CT, abdominal ultrasonography
DiffDx Kidney stones, genitourinary malignancy, loin pain haematuria syndrome
Management Nephrectomy, nephropexy, renocaval reimplantation, auto-transplantation, left renal vein transposition, stenting, gonadal vein embolisation

nut·crack·er syn·drome

(nut'krak-ĕr sin-drōm')
Nonglomerular hematuria due to compression of the left renal vein between the aorta and superior mesenteric artery; renal hilar varices, collateral veins, and proteinuria may be found.
References in periodicals archive ?
5] The donor in this case underwent a left nephrectomy, although no signs of the nutcracker syndrome were present on preoperative imaging.
Nutcracker syndrome refers to the compression of the left renal vein between the aorta and the superior mesenteric artery, which results in elevated left renal vein pressure and possible collateral vein development.
Nutcracker syndrome can have several clinical manifestations.
2) Nutcracker syndrome should be part of the differential consideration in the evaluation for hematuria when other etiologies have been excluded.
Other etiologic hypotheses of nutcracker syndrome include posterior renal ptosis with resultant stretching of the left renal vein over the aorta, and abnormal branching of the superior mesenteric artery from the aorta.
However, no clear consensus exists on the cutoff of pressure gradient with which nutcracker syndrome can be clearly diagnosed.
Doppler ultrasound measurements of the anterior-posterior (A-P) diameter and peak velocities of the left renal vein may be helpful in diagnosing nutcracker syndrome.
Distinguishing between distended left renal veins that are a normal variant and those that indicate early nutcracker syndrome is difficult in patients with borderline left renal vein hypertension.
Controversy also exists regarding treatment of nutcracker syndrome.
Syndromes associated with the deep veins: phlegmasia cerulea dolens, May-Thurner syndrome, and nutcracker syndrome.
5) The sagittal plane is especially useful for evaluation of nutcracker syndrome.
5) The transposition of the left renal vein to a more caudal location has been successfully used in nutcracker syndrome.