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.