Prevalence and Incidence of Clinical Symptoms of the Retroaortic Left Renal Vein

Abstract

Objective: To analyze the prevalence and incidence of clinical symptoms of retroaortic left renal vein (RLRV) diagnosed incidentally over 10 years by computed tomography (CT). Patients and Methods: 7,929 consecutive patients (out- and inpatients) were studied with multidetector CT from January 2000 to April 2011. We retrospectively reviewed RLRV patients' medical records and analyzed their clinical characteristics. Results: A total of 61 out of 7,929 patients had a RLRV, therefore the prevalence was 0.77%. Only 4 of 61 (6.6%) RLRV patients diagnosed by CT scan were clinically symptomatic. RLRV was associated with flank pain and microhematuria in one patient (1.6%), in another one with microhematuria only and in one with ureteropelvic junction obstruction. Furthermore, one patient suffered from arterial hypertension associated with a RLRV. Conclusions: RLRV is a rare finding, and only a small minority of RLRVs causes symptoms.

Unusual Drainage of the Bifurcated Left Renal Vein Into a Dilated Lumbar Azygos Vein and Inferior Vena Cava

“…20 Renal venous anomalies are usually asymptomatic, but retroaortic course, called also posterior nutcracker syndrome, may cause flank pain, macrohematuria or microhematuria, proteinuria, abdominal pain, left gonadal varicose veins, and pelvic congestion syndrome. [5][6][7] To our best knowledge, the case where one of the bifurcated branches of the left renal vein drained into the lumbar AV, which continued in the chest as a dilated AV, while the other left renal vein branch drained into the IVC, had not been reported previously.…”

“…Renal venous anomalies are usually asymptomatic, but retroaortic course, called also posterior nutcracker syndrome, may cause flank pain, macrohematuria or microhematuria, proteinuria, abdominal pain, left gonadal varicose veins, and pelvic congestion syndrome. 5 –7…”

“…3,4 In case of a retroaortic left renal vein course, compression between aorta and vertebral column may cause venous dilatation, and in consequence the posterior nutcracker syndrome resulting in episodes of hematuria, proteinuria, flank pain, thrombosis, and dilatation of the left ovarian or testicular veins which may cause pelvic congestion syndrome. [5][6][7][8] Case Report…”

Anatomical variants of renal veins: A meta-analysis of prevalence

“…For example, Gibo and Onitsuka described the case of a 13 years old girl who accused macrohematuria and low back pain; during the clinical investigation, it was found to have a RLRV, with compression of the vein between the aorta and the spine, causing an increased pressure gradient between the LRV and the IVC (mean of 6.8 mm Hg) 4 (a value above 3 being indicative for renal vein hypertension).• Can lead to hematuria. For example, Karaman showed that compression of the RLRV is significantly associated with hematuria (out of 16 patients with compression of the RLRV, 15 patients were in the urological group); moreover, the urologic symptomatology was more frequent in RLRV types II and IV 9 .• Can cause left flank 52 or low-back pain 4 • Can cause ureteropelvic junction obstruction 52 • Renin sampling from the renal vein 3 ; a false lower renin level can be obtained with the catheter tip in the proximal portion of the left renal vein, due to additional supply from the left gonadal, second lumbar and hemiazygous veins 114 • Increase the intrarenal venous impedance index 103 , potentially causing nephrolithiasis or renal cysts 39 MRVs• Injury during surgery 31 • Changes needed of the standard surgery protocol for renal transplantation, aneurysm resection 31 …”

Coexistence of the Aortic Aneurysm with the Main Vein Anomalies: Its Potential Clinical Implications and Vascular Complication

“…According to Karaman et al [34], studying the frequency of the RLRV was significantly higher in the group with urological symptoms, especially in patients with hematuria, in comparison with the other group without urological symptoms. Heidler et al [48] described that only 4 of 61 (6.6%) patient with RLRV diagnosed by CT scan were clinical symptomatic (flank pain and microhematuria).…”