Association of Congenital Left Renal Vein Anomalies and Unexplained Hematuria: Multidetector Computed Tomography Findings

Abstract

Objectives: To investigate whether congenital renal vein anomalies are involved in the etiology of hematuria by analyzing abdominal multidetector computed tomography (MDCT) results. Methods: Six hundred and eighty patients undergoing MDCT for various abdominal pathologies in whom possible causes of hematuria were excluded were retrospectively assessed in terms of left renal vein anomalies, such as circumaortic left renal vein (CLRV), retroaortic left renal vein (RLRV) and multiple renal vein (MRV). Patients with CLRV, RLRV or MRV and patients with normal left renal veins were compared in terms of the presence of hematuria. Results: Left renal vein anomalies were detected in 100 patients (14.7%). RLRV, CLRV and MRV were identified in 5.4, 2.5 and 6.8% of patients, respectively. Hematuria was determined in 8.1% of patients with an RLRV anomaly and in 10.5% of patients with no RLRV anomaly (p = 0.633). Hematuria was detected in 23.5% of patients with a CLRV anomaly and 10.1% of those without (p = 0.074), and in 21.7% of patients with an MRV anomaly and 9.6% of those without (p = 0.009). Conclusions: In addition to increasing risk of complication during retroperitoneal surgery, numeric congenital renal vein anomalies are also significant in terms of leading to clinical symptoms such as hematuria.

Anterior and posterior nutcracker syndrome accompanying left circumaortic renal vein in an adolescent. Case report

“…It is important to be aware of these variants before a surgical procedure, which can lead to hemorhage of the dorsal vein. 6 De Schepper described the entrapment of the LRV between the SMA and the aorta as anterior nutcracker syndrome. The posterior analog of the compression between the aorta and the vertebral column is known as posterior nutcracker syndrome.The term 'posterior nutcracker syndrome' refers to the left renal venous hypertension secondary to the compression of the retroaortic left renal vein, which crosses between the aorta and the vertebral column.…”

Síndrome del cascanueces anterior y posterior acompañado de vena renal izquierda circumaórtica en un adolescente. A propósito de un caso

“…Es importante tener conocimiento de estas variantes antes de realizar un procedimiento quirúrgico, lo que podría derivar en una hemorragia de la vena dorsal. 6 De Schepper describió la compresión de la VRI entre la AMS y la aorta como síndrome del cascanueces anterior. La compresión análoga posterior entre la AMS y la columna vertebral se denomina síndrome del cascanueces posterior.…”

Anterior Nutcracker Syndrome with Left Gonadal Vein Varicosities on Multiphasic Computed Tomography: An Unexpected Cause of Pyeloureteral Junction Obstruction

“…It has been postulated, in fact, that the increased pressure within the LRV can cause the development of varices in the venous peripyelic and the periureteral bed; the rupture of the thin septa between the small varices and collecting system, especially in the calyceal fornix, can result in hematuria [3,4,5]. For the same reason, it can produce congestion of the gonadal vein with dilatation, venous reflux, and development of varicocele or ovarian vein congestion.…”

“…Clinically, this condition can be silent or involve episodes of hematuria (macro-/microscopic) [3,4,5]; orthostatic proteinuria has also been reported [6]. Other symptoms include flank pain and discomfort in the pelvic or scrotal area caused by a varicocele or ovarian vein congestion [6].…”