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Our Clinical Experiences in Patients with Nutcracker Syndrome [Behcet Uz Cocuk Hast Derg]
Behcet Uz Cocuk Hast Derg. 2021; 11(1): 9-14 | DOI: 10.5222/buchd.2021.54366  

Our Clinical Experiences in Patients with Nutcracker Syndrome

Hatice Sonay Yalcin Comert1, Elif Bahat Özdoğan2, Sema Tural Bozoğlu1, Gül Şalcı1, Haluk Sarıhan1, Mustafa Imamoğlu1
1Karadeniz Technical University, Faculty Of Medicine, Department Of Pediatric Surgery, Trabzon, Turkey
2Karadeniz Technical University, Faculty Of Medicine, Department Of Pediatric Nephrology, Trabzon, Turkey

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


Nutcracker Sendromlu Hastalarda Klinik Deneyimlerimiz

Hatice Sonay Yalcin Comert1, Elif Bahat Özdoğan2, Sema Tural Bozoğlu1, Gül Şalcı1, Haluk Sarıhan1, Mustafa Imamoğlu1
1Karadeniz Teknik Üniversitesi Tıp Fakültesi, Çocuk Cerrahisi Anabilim Dalı, Trabzon
2Karadeniz Teknik Üniversitesi Tıp Fakültesi, Çocuk Nefrolojisi Anabilim Dalı, Trabzon

GİRİŞ ve AMAÇ: Nutcracker sendromu (NCS), abdominal aorto ve superiar mezenterik arter arasındaki sol renal
venin sıkışmasından kaynaklanan nadir bir durumdur. Çalışmanın amacı, NCS tanısı konulan hastalara
genel yaklaşımımızı değerlendirmektir.
YÖNTEM ve GEREÇLER: Hastalar retrospektif olarak incelendi ve cinsiyet, yaş, uygulamadaki ana semptomlar, fizik muayene, radyolojik bulgular, laboratuvar muayeneleri ve tedavi kaydedildi.
BULGULAR: 23 hasta (16 kız, 7 erkek; yaş aralığı, 5-16) NKS tanısı aldı. Tanıdan önce 14 hastada (% 60,8) mikrohematüri saptandı. Teşhisten 9 taneden dördünde (% 39.1) tanı aldıktan sonra belirlendi. Hastaların 5'inde (% 21.7) mikrohematüri saptanmadı. Tüm hastalarda (% 100) ortostatik proteinüri vardı. 17 (% 73.9) hastada hafif, 3 (% 13.0) hastada orta, 3 (% 13.0) hastada ciddi proteinüri vardı. Aortmezenterik (AM) ve hilerde sol renal venin (LRV) ortalama çapı 1.69mm ± 0.70 ve 8.01mm ± 2.27 idi. Üst mezenterik arter ve LRV arasındaki ortalama açı 25.26 ± 7.98 idi.
TARTIŞMA ve SONUÇ: Özellikle kolik yan ağrısı, hematüri ve proteinüri olması durumunda NCS ayırıcı tanıda akılda tutulmalıdır. Cerrahi tedavi, hasta tıbbi tedaviye yanıt verdiğinde daha fazla klinik iyileşme sağlayabilir.

Anahtar Kelimeler: Nutcracker sendromu, renal kolik, hematüri, proteinüri


Hatice Sonay Yalcin Comert, Elif Bahat Özdoğan, Sema Tural Bozoğlu, Gül Şalcı, Haluk Sarıhan, Mustafa Imamoğlu. Our Clinical Experiences in Patients with Nutcracker Syndrome. Behcet Uz Cocuk Hast Derg. 2021; 11(1): 9-14

Corresponding Author: Hatice Sonay Yalcin Comert, Türkiye


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