The nutcracker phenomenon accompanied by renin-dependent hypertension

Hosotani, Yoko; Kiyomoto, Hideyasu; Fujioka, Hikaru; Takahashi, Norihiro; Kohno, Masakazu

doi:10.1016/s0002-9343(03)00091-3

Cited by 24 publications

(17 citation statements)

References 6 publications

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“…In a study measuring plasma renin and angiotensin II levels in a 23-year-old patient with neurosyphilis, blood tests demonstrated increased plasma renin and angiotensin II activity in the LRV despite the absence of renal artery stenosis or a renin-producing tumor. These studies became normalized after endovascular stent placement [25]. Angiotensin II exerts hemodynamic and non-hemodynamic effects on the kidney.…”

Section: Discussionmentioning

confidence: 99%

Multidetector computed tomography findings and correlations with proteinuria in nutcracker syndrome

et al. 2009

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We evaluated the effectiveness of multidetector computed tomography (MDCT) as a diagnostic tool for nutcracker syndrome (NS) and its association with proteinuria. The angle and distance between the aorta and the superior mesenteric artery (SMA), the degree of difference in corticomedullary enhancement (DCE) between kidneys in the nephrographic phase of computed tomography, peak velocity ratio (PVR), and anteroposterior diameter ratio (APDR) in the sonogram were measured. The MDCT results, sonogram results, and the ratio of protein:creatinine were significantly different between NS patients and the controls. The area under the curve for angle, distance, and DCE were 0.895 +/- 0.058, 0.876 +/- 0.063, and 0.942 +/- 0.036, respectively. The cutoff values for angle and distance had sensitivity and specificity values of 96.2 and 80% for <22.4 degrees and 84.6 and 80% for <4.9 mm, respectively. The DCE had a sensitivity of 88.5% and a specificity of 100% for the positive scores. There were significant correlations between the degree of DCE and the ratio of protein:creatinine (r = 0.337, p = 0.031), and between distance and the ratio of protein:creatinine (r = -0.419, p = 0.006). We conclude that MDCT has diagnostic value for NS in children and that MDCT findings are correlated with proteinuria.

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Section: Discussionmentioning

confidence: 99%

Multidetector computed tomography findings and correlations with proteinuria in nutcracker syndrome

et al. 2009

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“…Furthermore, other medical therapies for nutcracker syndrome may include angiotensin-converting enzyme inhibitors to improve orthostatic proteinuria and aspirin to improve renal perfusion. 23,24 In conclusion, one of the rare causes for severe bilious vomiting may be SMA syndrome, even in a young adult male, and physicians should be mindful of the possibility of SMA syndrome, especially if the patient has significant weight loss; plain X-ray as well as abdominal CT or upper gastrointestinal series scan may have diagnostic value. It may be important to consider concurrent occurrence of renal nutcracker syndrome with the diagnosis of SMA syndrome.…”

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confidence: 99%

Superior Mesenteric Artery Syndrome Combined with Renal Nutcracker Syndrome in a Young Male: A Case Report

2017

Korean J Gastroenterol

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Superior mesenteric artery (SMA) syndrome is one of the rare causes of small bowel obstruction. It develops following a marked decrease in the angle between SMA and the abdominal aorta due to weight loss, anatomical anomalies, or following surgeries. Nutcracker syndrome in the left renal vein may also occur following a decrease in the aortomesenteric angle. Though SMA syndrome and renal nutcracker syndrome share the same pathogenesis, concurrent development has rarely been reported. Herein, we report a 23-year-old healthy male diagnosed with SMA syndrome and renal nutcracker syndrome due to severe weight reduction. The patient visited our outpatient clinic presenting bilious vomiting and indigested vomitus for 3 consecutive days. He had lost 20 kg during military service. We suspected SMA syndrome based on abnormal air-shadow in the stomach and small bowel on abdominal X-ray; we confirmed compression of the third portion of the duodenum with upper gastrointestinal series and abdominal computed tomography (CT). Concurrently, renal nutcracker syndrome was also detected via abdominal CT and Doppler ultrasound. Considering bilious vomiting and no urinary symptoms, SMA syndrome was corrected by laparoscopic duodenojejunostomy, and close observation for the renal nutcracker syndrome was recommended. (Korean J Gastroenterol 2017;70:253-260)

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“…Hosotani et al [10] reported a case of NCP and hypertension with increased plasma renin and aldosterone levels in the peripheral blood in a young Japanese woman. The patient was found severe LRV stenosis and ovarian veins dilated via selective renal venography.…”

Section: Discussionmentioning

confidence: 99%

An Incidental Detection of Nutcracker Phenomenon in an Adolescent with Transient High Blood Pressure: A Case Report

Min¹,

Chen²,

Wang³

et al. 2016

CRCM

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Nutcracker phenomenon (NCP) is caused by a compression of left renal vein between aorta and superior mesenteric artery. The traditional clinical manifestations of nutcracker syndrome is usually accompanied with abdominal pain, hematuria, orthostatic proteinuria, and varicocele formation, however, hypertension is rarely reported as main clinical feature. We describe a male adolescent with manifestation of hypertension who was identified as NCP. Renal ultrasound and computed tomography angiography have provided evidences of left renal vein dilatation, probably due to the compression through the decreased angle between aorta and superior mesenteric artery. There were no other signs for secondary hypertension for the blood levels of renin and aldosterone being between normal limits and urinalysis being negative of hematuria and proteinuria. This patient was conservatively observed without any anti-hypertensive drugs and was asked for appropriately putting on weight. Three months later, the hypertension symptom was alleviated. In conclusion, although there were no established direct pathogenetic links between hypertension and NCP, no other definite etiology was shown to be the cause of this main manifestation. Thus we speculate that the NCP might be the main cause of hypertension in this patient.

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The nutcracker phenomenon accompanied by renin-dependent hypertension

Cited by 24 publications

References 6 publications

Multidetector computed tomography findings and correlations with proteinuria in nutcracker syndrome

Multidetector computed tomography findings and correlations with proteinuria in nutcracker syndrome

Superior Mesenteric Artery Syndrome Combined with Renal Nutcracker Syndrome in a Young Male: A Case Report

An Incidental Detection of Nutcracker Phenomenon in an Adolescent with Transient High Blood Pressure: A Case Report

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