Nutcracker syndrome

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Nutcracker syndrome
Synonyms	Renal vein entrapment syndrome
Pronounce	N/A
Specialty	Nephrology, Vascular surgery
Symptoms	Hematuria, flank pain, varicocele, pelvic congestion syndrome
Complications	Renal vein thrombosis, chronic kidney disease
Onset	Typically young adults
Duration	Chronic
Types	N/A
Causes	Compression of the left renal vein
Risks	Connective tissue disorders, weight loss
Diagnosis	Doppler ultrasound, CT scan, MRI, venography
Differential diagnosis	Pelvic congestion syndrome, varicocele, renal artery stenosis
Prevention	N/A
Treatment	Endovascular stenting, surgical decompression, nephrectomy
Medication	N/A
Prognosis	Variable, depending on severity and treatment
Frequency	Rare
Deaths	N/A

A condition involving compression of the left renal vein

Compression of the left renal vein (marked by the arrow) between the superior mesenteric artery (above) and the aorta (below) due to nutcracker syndrome.

Thrombosis in the left renal vein associated with dilation.

A nutcracker. The legs of this nutcracker, with some imagination, could represent the superior mesenteric artery and abdominal aorta in nutcracker syndrome.

Nutcracker syndrome is a vascular compression disorder characterized by the compression of the left renal vein (LRV) between the abdominal aorta and the superior mesenteric artery. This condition can lead to a variety of symptoms due to impaired blood flow from the left kidney.

Pathophysiology

The term "nutcracker syndrome" is derived from the visual analogy of the LRV being compressed between the aorta and the superior mesenteric artery, similar to a nut being cracked open. This compression can lead to increased venous pressure in the left renal vein, resulting in the development of collateral circulation and potential varicosities in the gonadal vein and other tributaries.

Symptoms

Symptoms of nutcracker syndrome can vary widely among patients. Common symptoms include:

• Hematuria (blood in urine)
• Flank pain or abdominal pain
• Proteinuria (protein in urine)
• Pelvic congestion syndrome
• Varicocele in males
• Fatigue and orthostatic intolerance

Diagnosis

Diagnosis of nutcracker syndrome typically involves a combination of clinical evaluation and imaging studies. Common diagnostic tools include:

• Doppler ultrasound
• CT angiography
• Magnetic resonance angiography (MRA)
• Venography

These imaging techniques help visualize the compression of the left renal vein and assess the degree of venous hypertension.

Treatment

Treatment options for nutcracker syndrome depend on the severity of symptoms and the degree of venous compression. Conservative management may include observation and symptomatic treatment. In more severe cases, surgical interventions may be necessary, such as:

• Endovascular stenting
• Renal vein transposition
• Autotransplantation of the kidney

Prognosis

The prognosis for individuals with nutcracker syndrome varies. Some patients may experience spontaneous improvement of symptoms, while others may require surgical intervention to alleviate symptoms and prevent complications.

See also

• Renal vein
• Superior mesenteric artery
• Abdominal aorta
• Vascular compression syndromes

External links

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