Renal Nutcracker syndrome

What is it?

Nutcracker syndrome (NCS) is a rare benign renal disease characterized by compression of the left renal vein between the superior mesenteric artery and abdominal aorta (in most cases) causing increased renal and pelvic venous pressure. The female sex is most affected. Patients are generally tall and thin. The disease is usually asymptomatic and accidentally diagnosed on imaging tests performed for other reasons.

Which are the symptoms?

Symptomatic patients present with symptoms primarily in the second or third decade of life. Symptoms include left lumbar or abdominal pain, macroscopic or microscopic hematuria, varicocele or varicose veins of the lower extremities. Other symptoms present are the same as those of pelvic congestion syndrome and include dysmenorrhea, dyspareunia, dysuria, and pelvic varices.

  • Lumbar Pain       
  • Abdominal pain       
  • Hematuria       
  • Pelvic varicocele       
  • Various of lower limbs       
  • Menstrual pain       
  • Pain during sexual intercourse
  • Pain during urination

How is it diagnosed?

Imaging examinations include echo-color Doppler, angio-CT or angio-RM, phlebography. Urinalysis is important to identify changes in urine with the presence of blood. Phlebography and intravascular ultrasound (IVUS) remain the gold standard for diagnosis with identification of the compression point.

Suggested exams

How is it treated?

In asymptomatic cases with mild symptoms, conservative approach with follow-up is recommended. For more severe symptoms, surgical and endovascular interventions have good results, including transposition of the left renal vein or implantation of a self-expanding intravascular metallic stent in the stenotic tract of the left renal vein.

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