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World J Nephrol. Nov 6, 2014; 3(4): 277-281
Published online Nov 6, 2014. doi: 10.5527/wjn.v3.i4.277
Nutcracker syndrome
Kaan Gulleroglu, Basak Gulleroglu, Esra Baskin
Kaan Gulleroglu, Esra Baskin, Department of Pediatric Nephrology, Baskent University, 06540 Ankara, Turkey
Basak Gulleroglu, Department of Radiology, Adana Numune Training and Research Hospital, 01123 Adana, Turkey
Author contributions: Gulleroglu K, Gulleroglu B and Baskin E contributed equally to this work; Gulleroglu K, Gulleroglu B and Baskin E analyzed the data; Gulleroglu K, Gulleroglu B and Baskin E wrote the paper.
Correspondence to: Kaan Gulleroglu, MD, Department of Pediatric Nephrology, Baskent University, 54. Cadde, No: 72/3, Bahcelievler, 06540 Ankara, Turkey. kaangulleroglu@yahoo.com
Telephone: +90-312-2234936 Fax: +90-312-2157597
Received: June 6, 2014
Revised: July 16, 2014
Accepted: September 17, 2014
Published online: November 6, 2014
Processing time: 153 Days and 18.3 Hours
Abstract

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.

Keywords: Nutcracker syndrome; Renal vein entrapment; Hematuria; Orthostatic proteinuria; Left renal vein hypertension

Core tip: 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. The symptoms vary from asymptomatic hematuria to severe pelvic congestion. The management of NCS depends upon the clinical presentation and the severity of the LRV hypertension.