Effect of renal Doppler ultrasound on the detection of nutcracker syndrome in children with hematuria

Shin, Jae Il; Park, Jee Min; Lee, Jae Seung; Kim, Myung Joon

doi:10.1007/s00431-006-0252-7

Cited by 122 publications

(106 citation statements)

References 14 publications

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“…1,[29][30][31] Patients' age can range from childhood to the seventh decade of life, but most symptomatic patients are in their second or third decade of life; there may be a second peak of NCS in middle-aged women. 3 Nutcracker phenomenon is not…”

Section: Demographic Characteristicsmentioning

confidence: 99%

Nutcracker Phenomenon and Nutcracker Syndrome

Kurklinsky¹,

Rooke

2010

Mayo Clinic Proceedings

444

586

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N utcracker phenomenon (NCP), also known as left renal vein entrapment,1-3 is characterized by impeded outflow from the left renal vein (LRV) into the inferior vena cava (IVC) due to extrinsic LRV compression, often accompanied by demonstrable lateral (hilar) dilatation and medial (mesoaortic) narrowing (schematic representation of NCP/ nutcracker syndrome [NCS] in Figure 1). Although the terms nutcracker syndrome and nutcracker phenomenon are sometimes used interchangeably in the literature, Shin and Lee 4 emphasize that the nutcracker anatomy is not always associated with clinical symptoms and that some of the anatomic findings suggestive of nutcracker may represent a normal variant or be accounted for by other conditions. Therefore, the term nutcracker syndrome should be reserved for patients with characteristic clinical symptoms associated with demonstrable nutcracker morphologic features. No consensus exists on what symptoms are severe enough to warrant the designation of a clinical syndrome or to what extent various findings may simply reflect different evolutionary stages of the process. Because of these uncertainties, some authors focus on the characteristic anatomic and hemodynamic findings, referring to them as NCP rather than NCS. 5Nutcracker phenomenon refers to compression of the left renal vein, most commonly between the aorta and the superior mesenteric artery, with impaired blood outflow often accompanied by distention of the distal portion of the vein. The nutcracker syndrome (NCS) is the clinical equivalent of nutcracker phenomenon characterized by a complex of symptoms with substantial variations. Depending on specific manifestations, NCS may be encountered by different medical specialists. Although it may be associated with substantial morbidity, the diagnosis of NCS is often difficult and is commonly delayed. Diagnostic and treatment criteria are not well established, and the natural history of NCS is not well understood. We performed an initial review of the literature through MEDLINE, searching from 1950 to date and using the keywords nutcracker syndrome, nutcracker phenomenon, and renal vein entrapment. We performed additional reviews based on the literature citations of the identified articles. We attempted to elucidate clinical relevance of these conditions and their prominent features and to summarize professional experience. Mayo Clin

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Section: Demographic Characteristicsmentioning

confidence: 99%

Nutcracker Phenomenon and Nutcracker Syndrome

Kurklinsky¹,

Rooke

2010

Mayo Clinic Proceedings

444

586

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“…Isolated hematuria was reported 33.3% in children with NCS. Microhematuria is 4 times more common than macrohematuria [16] . Orthostatic proteinuria is another common symptom in NCS.…”

Section: Clinical Featuresmentioning

confidence: 99%

Nutcracker syndrome

Gulleroglu

Gülleroğlu

Baskın

2014

WJN

128

163

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The nutcracker phenomenon [left renal vein (LRV) entrapment syndrome] refers to compression of the LRV most commonly between abdominal aorta and superior mesenteric artery. Term of nutcracker syndrome (NCS) is used for patients with clinical symptoms associated with nutcracker anatomy. LRV entrapment divided into 2 types: anterior and posterior. Posterior and right-sided NCSs are rare conditions. The symptoms vary from asymptomatic hematuria to severe pelvic congestion. Symptoms include hematuria, orthostatic proteinuria, flank pain, abdominal pain, varicocele, dyspareunia, dysmenorrhea, fatigue and orthostatic intolerance. Existence of the clinical features constitutes a basis for the diagnosis. Several imaging methods such as Doppler ultrasonography, computed tomography angiography, magnetic resonance angiography and retrograde venography are used to diagnose NCS. The management of NCS depends upon the clinical presentation and the severity of the LRV hypertension. The treatment options are ranged from surveillance to nephrectomy. Treatment decision should be based on the severity of symptoms and their expected reversibility with regard to patient's age and the stage of the syndrome.

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“…It is primarily due to high LRV pressure end to the rupture of the thin-walled septum between the small veins and the collecting system in the renal fornix (8). An incidence rate about 33% among children with microscopic hematuria was reported in literature for nutcracker syndrome (9). The study patient was thin and her abdominal pain was exaggerated by physical activities.…”

Section: Discussionmentioning

confidence: 79%

The Nutcracker Syndrome as a Rare Cause of Chronic Abdominal Pain: A Case Report

Pournasiri

2016

J Compr Ped

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Introduction: Renal vein entrapment, named nutcracker phenomenon, is a contraction of renal vein between abdominal aorta and superior mesenteric artery. Patients can be asymptomatic or clinically manifested, called nutcracker syndrome. Proteinuria, hematuria, flank pain, varicocele in males and pelvic congestion in females are reported in such patients. Case Presentation: The current report presented an eight-year-old girl with microscopic hematuria and chronic abdominal pain along with short review of anatomy, pathophysiology, clinical significance and management of this syndrome. Conclusions:The nutcracker syndrome should be differentiated from unexplained chronic abdominal pain.

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Effect of renal Doppler ultrasound on the detection of nutcracker syndrome in children with hematuria

Cited by 122 publications

References 14 publications

Nutcracker Phenomenon and Nutcracker Syndrome

Nutcracker Phenomenon and Nutcracker Syndrome

Nutcracker syndrome

The Nutcracker Syndrome as a Rare Cause of Chronic Abdominal Pain: A Case Report

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