Abstract
INTRODUCTION
Nutcracker syndrome (NCS) is a rare condition caused by the compression of the left renal vein
between the abdominal aorta and superior mesenteric artery. The purpose of the study was to evaluate
our management of NCS.
METHODS
Patients were retrospectively reviewed and sex, age, main symptoms at application, physical
examination, radiological findings, laboratory examinations, and treatment were recorded.
RESULTS
23 patients (16 girls, 7 boys; age range, 5 to 16) diagnosed with NCS. Microhematuria was
detected with 14 (60.8%) patients before diagnosis. And four of 9 (39.1%) were determined after
diagnosis. Microhematuria was not detected in 5 (21.7%) of the patients. All patients (100%) had
orthostatic proteinuria. 17 (73.9%) patients had mild, 3 (13.0%) patients had moderate and 3 (13.0%) had
severe proteinuria. The mean diameter of the left renal vein (LRV) at the aortomesenteric (AM) portions
and the hilar were 1.69mm±0.70 and 8.01mm±2.27. The mean angle between the superior mesenteric
artery and LRV was 25.26º±7.98.
DISCUSSION AND CONCLUSION
In the case of especially colic flank pain, hematuria, and proteinuria NCS should keep in mind
in the differential diagnosis. Surgical management may supply more enough clinic improvement when the
patient has a response to medical therapy.
Keywords: Nutcracker syndrome, renal colic, hematuria, proteinuria
